Laser therapy endovenous

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

ELT; endoluminal laser therapy; endovenous laser ablation; endovenous laser therapy; endovenous laser treatment

Definition
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Minimally invasive method for the therapy of varicose veins, in which a laser fibre is used to induce physical damage to the vein wall (indirect heat effect) and closure of the vein.

General definition
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  • The placement of the laser fibre is carried out in Seldinger technique using a guide wire and catheter in sonographic control. A transcutaneously visible red pilot beam of the laser serves as a supplementary control for the correct positioning of the fiber tip (only visible in the darkened operating room).
  • After transmission of light energy, blood remaining in the vein absorbs the laser energy and vaporizes. This causes a vapor bubble to form and heat damage to the inner vessel wall. The vascular lumen only closes secondarily in the course of a few hours after the procedure due to a thrombus.
  • Commonly used wavelengths of laser light are 810 nm, 940 nm and 980 nm. A minimum energy of 60-80 J/cm vein is recommended.
  • For the wavelength 1320 nm, 8 W laser power is currently used, at about 60 J/cm vein.
  • Experimental: Good individual results with low postoperative pain intensity were achieved for ELT using a thulium laser (1940 nm) and radial light application.

Indication
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Trunk varicose v eins of V. saphena parva or V. saphena magna or side branch varicose veins. The indication largely corresponds to other surgical procedures (see below varicose vein surgery; see below crossectomy).

Undesirable effects
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Postoperative pain in the course of the treated truncal veins is to be expected. They are classified by most patients (about 8o%) as mild to moderate. Approximately 18% of those treated describe severe to very severe pain. Parvenous haematomas are described in about 50% of the patients. Phlebitis of the truncal vein occurs in about 3-17% of the patients treated. Other less frequent complications are dysesthesia, skin burns, pulmonary embolism.

Note(s)
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Currently data with 20,000 ELT treatments are available. With adequate patient selection, ELT treatment with successful probing of the truncal vein is technically possible in > than 99% of patients. With meta-analytical workup, an average incidence of non-occlusions or early recanalizations of 2.3% is calculated. In long-term studies (>60 months) recanalizations of > 20% are found.

Literature
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  1. Go SJ et al (2016) Study on the Long-Term Results of Endovenous Laser Ablation for Treating Varicose Veins. Int J Angiol 25:117-120.
  2. Han, M et al (2006) Endoluminal catheter-based laser therapy of truncal vein insufficiency. Dermatologist 57: 26-32
  3. Min RJ et al (2003) Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc interval Radiol 14: 991-996
  4. Nüllen H et al (2010) Surgery of perforators varicosis. In: T Noppeney, H Nüllen Diagnosis and therapy of varicosis. Springer Medicine Publishing House Heidelberg S 349-357
  5. Oh CK et al (2003) Endovenous laser surgery of the incompetent greater saphenous vein with a 980-nm diode laser. Dermatol Surgery 29: 1135-1140
  6. Proebstle TM, Lehr HA, Kargl A et al (2002) Endovenous treatment of the greater saphenous vein with a 940 nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser generated steam bubbles. J Vasc Surg 35: 729-36
  7. Proebstle TM et al (2004) Nonocclusion and early reopening of the great saphenous vein after endovenous laser treatment is fluence dependent. Dermatol Surgery 30: 174-178
  8. Schmedt CG et al (2014) First clinical results of endovenous laser therapy with thulium laser (1940 nm) and radial light application. Vasomed 26: 294-295

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Last updated on: 29.10.2020