Optimization of endovenous laser coagulation: in vivo experiments

Artemov, S. A.; Belyaev, Alexander N.; Bushukina, O. S.; Khrushchalina, S.A.; Kostin, S. V.; Lyapin, A.A.; Ryabochkina, P. A.; Taratynova, A.D.

doi:10.1007/s10103-019-02874-6

Cited by 11 publications

(4 citation statements)

References 20 publications

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“…Artemov et al used a 1910 nm-laser system with bare fiber irradiation with increasing power in an animal model. 27 Laser power of 1.5 W (LEED 7,5 J/cm) led to asymmetric, incomplete destruction of the vein and hence recanalization. Using 3 W (LEED 15 J/cm) and 4 W (LEED 20 J/cm) caused more pronounced venous wall damage.…”

Section: Discussionmentioning

confidence: 99%

“…Based on these physical backgrounds, it was logical that EVLA with 1940 nm with radial fiber should be clinically evaluated for its efficacy and safety. A few studies have reported their experiences with laser systems of wavelength >1900 nm in clinical 26 and experimental 21,27 studies. De Araujo et al compared 1940 and 1470 nm laser in an ex vivo model 21 .…”

Section: Discussionmentioning

confidence: 99%

“…They demonstrated that, with similar LEED values, 1940 nm laser caused higher thermal damage to the vein intima, as compared to the 1470 nm laser. Artemov et al used a 1910 nm‐laser system with bare fiber irradiation with increasing power in an animal model 27 . Laser power of 1.5 W (LEED 7,5 J/cm) led to asymmetric, incomplete destruction of the vein and hence recanalization.…”

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of endovenous laser ablation (EVLA) using 1940 nm and radial emitting fiber: 3‐year results of a prospective, non‐randomized study and comparison with 1470 nm

Setia

Schmedt²,

Beisswenger³

et al. 2021

Lasers Surg Med

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To evaluate the safety, efficacy and ≥36 months outcomes of endovenous laser ablation (EVLA) by means of 1940 nm laser with radial fiber for the treatment of truncal vein insufficiency and compare the results to a historical cohort, obtained via reviewing the literature. Methods: This prospective, non-randomized, single-center clinical study included 139 consecutive patients with 177 incompetent great saphenous (GSV, n = 135) and short saphenous veins (SSV, n = 42). The maximum laser power (Pmax. 10 W) and pullback velocity were adjusted individually (V max = 1 mm/s). The laser fiber was placed at the junction to the deep vein under duplex monitoring. Simultaneous phlebectomies were performed on all the patients. Regular follow up with clinical and duplex ultrasound examination (DUS) were carried out postoperatively at 1 month (1 M), 6 months (6 M), 12 months (12 M), 24 months (24 M), 36 months, and after that (≥36 M). The results were compared with three cohorts (total 616 EVLA procedures with 1470 nm laser and radial fiber) from literature (criteria: >100 procedures, follow-up of ≥2 years). Results: The follow-up rate was 100%, 91%, 73%, 48%, and 23% of the truncal veins at 1, 6, 12, 24, and ≥36 M, respectively. In comparison to the literature using 1470, a lower average linear endovenous energy density (LEED) (53 vs. 77-82 J/cm) resulted in 100% (6 M) and 96.5% (24 M) occlusion rates, reduced local ecchymosis (2.2% vs. 3.2%-18.7%) and reduced average postoperative pain levels (1.3 vs. 2.18). Regarding adverse events, induration (1.1% vs. 1.8%), skin burns (0% vs. 0.45%), endovenous heat-induced thrombus propagation (EHIT) in the deep veins (2.3% vs. 1.8%) and laser-induced persistent paresthesia (2.2% vs. 0.5%-2.9%) were comparable. Recanalizations observed in this study (GSV 0, SSV 3) were asymptomatic and required no treatment. At ≥36 M reflux in the accessory veins was observed in 5% versus 10.5% of patients. Reintervention was required in none (0% vs. 21%). At >36 M, short average stump lengths of 1 cm (GSV) and 0.3 cm (SSV) were observed. Conclusion: EVLA with 1940 nm laser with radial emitting fiber is as safe and effective as 1470 nm laser for the treatment of truncal vein insufficiency. Lower postoperative pain, low analgesic requirements, short convalescence add to patients' comfort. EVLA with 1940 nm laser-guided by intraoperative DUS permits reproducible placement of the radial fiber at the saphenofemoral and saphenopopliteal junction, enabling further studies to assess the effect of shorter stump length on patterns and frequency of recurrence without increased risk of EHIT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Safety and efficacy of endovenous laser ablation (EVLA) using 1940 nm and radial emitting fiber: 3‐year results of a prospective, non‐randomized study and comparison with 1470 nm

Setia

Schmedt²,

Beisswenger³

et al. 2021

Lasers Surg Med

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“…Frequently, medical laser systems of the 2 µm spectral range operate in continuouswave (CW) and nanosecond or longer pulsed modes [21][22][23]. These laser systems are mainly based on linear absorption of laser radiation by tissues, due to the relatively low peak intensity of the radiation, which is insufficient to induce a noticeable nonlinear interaction at initial average powers.…”

Section: Introductionmentioning

confidence: 99%

Ex Vivo Exposure to Soft Biological Tissues by the 2-μm All-Fiber Ultrafast Holmium Laser System

et al. 2022

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We present the results of ex vivo exposure by an ultrafast all-fiber Holmium laser system to porcine longissimus muscle tissues. A simple Ho-doped laser system generated ultrashort pulsed radiation with less than 1 ps pulse width and a repetition rate of 20 MHz at a central wavelength of 2.06 μm. Single-spot ex vivo experiments were performed at an average power of 0.3 W and different exposure times of 5, 30 and 60 s, varying the total applied energy in the range of 1.5–18 J. Evaluation of laser radiation exposure was performed according to the depth and diameter of coagulation zones, ablation craters and thermal damage zones during the morphological study. Exposure by ultrashort pulsed radiation with an average power of 0.3 W showed destructive changes in the muscle tissue after 5 s and nucleation of an ablative crater. The maximum ablation efficiency was about 28% at the ablation depth and diameter of 180 μm and 500 μm, respectively. The continuous-wave radiation impact at the same parameters resulted only in heating of the near-muscular tissue, without ablation and coagulation traces. Exposure to tissue with an average power at 0.3 W of ultrashort pulsed radiation led, within 30 and 60 s, to similar results as caused by 0.5 W of continuous-wave radiation, although with less carbonization formation.

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