Systematic review of endovenous laser treatment for varicose veins

Mundy, Linda M.; Merlin, Tracy; Fitridge, Robert; Hiller, Janet E.

doi:10.1002/bjs.5142

Cited by 192 publications

(121 citation statements)

References 22 publications

(74 reference statements)

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“…2,4 When compared with open varicose vein surgery, EVLT results in decreased pain, earlier return to work, 5 improved patient satisfaction and improved quality of life. 6,7 Single-visit EVLT and phlebectomy procedures have shown reduced need for secondary procedures and improved short-term results. 8 Outpatient radiofrequency ablation (ClosureFast; Covidien, Dublin, Ireland) and EVLT are under investigation.…”

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Single-visit endovenous laser treatment and tributary procedures for symptomatic great saphenous varicose veins

Alder

Rahi

2014

annals

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INTRODUCTION Endovenous ablation of saphenous varicose veins has decreased morbidity and recovery time compared with open surgery. This study assessed the outcome and mid-term patient satisfaction of single-visit endovenous laser treatment (EVLT) alone, EVLT combined with phlebectomies and endovenous chemical ablation. METHODS A retrospective review was conducted of all patients (n=91) in 2008-2009 who underwent single-visit day-case EVLT using local anaesthesia under a single surgeon. Postoperative venous ultrasonography at 2 and 14 months was reviewed. A telephone questionnaire was carried out to assess recurrence of symptoms and quality of life at 42 months. RESULTS Overall, 124 limbs underwent day-case EVLT under local anaesthesia using an 810nm diode laser at a continuous setting of 14W. Forty-eight of these underwent EVLT alone while fifty underwent EVLT with phlebectomies and twenty-six underwent EVLT with endovenous chemical ablation. Ninety-one per cent of limbs underwent two-month postoperative imaging. All had satisfactory great saphenous vein (GSV) ablation (anterior thigh vein patency: n=1). The majority (84%) of limbs underwent 14-month imaging with a 98% GSV ablation rate. Three per cent had anterior thigh vein and saphenofemoral junction incompetence. Recurrence of GSV patency and reflux was <1%. The response rate to the questionnaire was 60%: 95% of respondents confirmed improvement following treatment, 62% remained symptom free at 42 months while 65% of patients with a return of symptoms deemed them mild. The questionnaire was scored out of 56 for symptoms and quality of life. Those with symptoms scored significantly higher. CONCLUSIONS At 42 months, the majority of limbs remained asymptomatic. The short-term GSV ablation rates were excellent. Overall mid-term review of patients has shown a well received single-visit service with concomitant phlebectomy or endovenous ablation, and good ablation and patient satisfaction rates.

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“…5 There is an increasing amount of data for recanalisation following endovenous ablation but extensive long-term results are pending. 6 Three-month occlusion rates vary between 87% and 100%. 4 The aim of this study was to assess the outcome and mid-term patient satisfaction of single-visit EVLT with phlebectomies or with endovenous chemical ablation.…”

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Single-visit endovenous laser treatment and tributary procedures for symptomatic great saphenous varicose veins

Alder

Rahi

2014

annals

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“…This common medical condition is now increasingly being treated by minimally invasive endovenous laser ablation (EVLA) because of excellent outcomes and low rates of complications and recurrences [2]. Although EVLA has demonstrated occlusion rates of 90% or more after several years of follow up studies [3][4][5][6][7], multiple laser wavelengths, laser powers and pullback velocities are currently in use. Most likely, this wide variation of commercially introduced laser parameters is a consequence of the current uncertainty in the mechanism of action of EVLA.…”

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confidence: 99%

Heat conduction from the exceedingly hot fiber tip contributes to the endovenous laser ablation of varicose veins

et al. 2009

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Lower-extremity venous insufficiency is a common condition, associated with considerable health care costs. Endovenous laser ablation is increasingly used as therapy, but its mechanism of action is insufficiently understood. Here, direct absorption of the laser light, collapsing steam bubbles and direct fiber-wall contact have all been mentioned as contributing mechanisms. Because fiber tips have reported temperatures of 800-1,300°C during endovenous laser ablation, we sought to assess whether heat conduction from the hot tip could cause irreversible thermal injury to the venous wall. We approximated the hot fiber tip as a sphere with diameter equal to the fiber diameter, having a steady state temperature of 800°C or 1,000°C. We computed venous wall temperatures due to heat conduction from this hot sphere, varying the pullback velocity of the fiber and the diameter of the vein. Venous wall temperatures corresponding to irreversible injury resulted for a 3 mm diameter vein and pullback velocities <3 mm/s but not for 5 mm and ≥1 mm/s. The highest wall temperature corresponded to the position on the wall closest to the fiber tip, hence it moves longitudinally in parallel with the moving fiber tip. We concluded that heat conduction from the hot fiber tip is a contributing mechanism in endovenous laser ablation.

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“…48 Önceki çalışmalar, bu ablasyonun alt ekstremitelerde %88-100 arasında başarılı oldu ğunu göster-mektedir. 49 Benzer başarı oranları radyofrekans ablasyon (RFA) için de söylenmektedir. 50,51 RFA, VSM, VSP ve perforan venleri lokal anestezi altında USG kılavuzluğunda tedavi etmek için kullanılan bir termal ablasyon tekniğidir.…”

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