Impact of Laser Fiber Design on Outcome of Endovenous Ablation of Lower-Extremity Varicose Veins: Results from a Single Practice

Abstract

The design of laser fibers used for endovenous laser ablation (EVLA) in the management of lower-extremity varicose vein disease may affect treatment success. The purpose of this investigation is to report our experience using the gold-tip NeverTouch VenaCure laser fiber (AngioDynamics, Queensbury, NY) and to compare that to our experience with standard bare-tip fibers. A retrospective chart review of 363 consecutive EVLA treatments using the gold-tip laser fiber was performed. Demographic data including patient age, sex, history of previous varicose vein stripping, vein identity, laterality, treatment length, total applied energy in joules (J), use of adjuvant sclerotherapy and ambulatory phlebectomy, treatment-related complications, and treatment failure, which was defined as recanalization of any portion of the treated vein during follow-up as assessed by duplex ultrasound examination-were entered into a spreadsheet. These data were compared with a control group of 471 EVLA treatments performed with a standard bare-tip laser fiber. Data were analyzed using independent-samples Student's t test, chi-square test, and multivariate analysis. Demographic data were similar between the two groups. Treatments with the gold-tip fiber had a failure rate of 11.1%, whereas treatment with a bare-tip fiber had a failure rate of 2.3% during a similar follow-up period. This difference was highly statistically significant (p<0.0001). Multivariate analysis showed fiber type as the most significant factor associated with treatment failure. We conclude that laser fiber design has a significant effect on treatment success in the performance of EVLA.

Comparison of Bare-Tip and Radial Fiber in Endovenous Laser Ablation with 1470 nm Diode Laser

“…22) The incidences of postoperative bruising and pain were significantly lower in the RF than in the BF group. In addition, the occlusion rate was 100% in the RF group, although LEED was significantly lower.…”

Comparison of 1470 nm Laser and Radial 2ring Fiber with 980 nm Laser and Bare-Tip Fiber in Endovenous Laser Ablation of Saphenous Varicose Veins: A Multicenter, Prospective, Randomized, Non-Blind Study

“…5) Recently, the usefulness of a laser at a WSLW of 1470 nm has been emphasized. [6][7][8] Furthermore, various types of optical fiber, such as jackettip, 9) diffusion, 10) and radial 11) fibers, have been developed. Among these, radial fibers are optical fibers that reflect the laser beam by means of a prism, and the laser energy is emitted in a 360-degree manner, thus allowing homogeneous irradiation of the vein wall and making it possible to prevent perforation.…”

Endovenous ablation of refluxing saphenous and perforating veins

“…A radial fi bre with radial emission of laser light has been combined with a wavelength of 1,470 nm showing good results [14,40]. One study reported the results with a covered fi bre tip, which has a metal tube-case and a glass weld at the distal tip, showing slightly lower occlusion rates than a bare tip [15]. One of the most recent inventions is the tulip tip that is designed to prevent perforations by centring the laser fi bre within self-expandable blades [16,41] and the 2-ring-radial fi bre which proved to cause less pain during the fi rst two weeks after EVLA compared to the 980 nm-bare-fi bre combination [42].…”

“…Later on, technological advances led to radiofrequency segmental thermal ablation (RSTA) [13] and introduction of higher laser wavelengths as well as development of radial [14], covered laser fi bre tips [15] or tulip tipped catheters [16]. In addition, steam was used as an alternative heat source [17].…”