Endovenous laser therapy and radiofrequency ablation of saphenous varicose veins

Radiofrequency ablation (RFA) and endovenous laser treatment (EVLT) are minimal invasive methods to treat saphenous varicose veins. The short- and mid-term results are excellent with an occlusion rate for RFA of almost 90% after 5 years and about 95% for EVLT after 2 years. Severe side effects are rare in both cases. Prospective randomised comparative studies are available for RFA and surgery showing comparable short-term results and superiority of RFA concerning short-term quality of life outcome. For laser treatment no prospective randomised comparative studies are available. Endovenous treatment is only a part of the complex treatment concept of varicose veins. Insufficient tributaries have to be treated in addition. The fact that the insufficient saphenous vein is treated without high ligation seems not to influence the short-term and mid-term recurrence rates. More prospective randomised comparative studies comparing endovenous treatment and surgery or foam sclerotherapy are necessary to decide which method is the best for which patient.     

Endovenous laser treatment of varicose veins

Endovenous laser treatment (EVLT) has become a standard therapy for the treatment of superficial venous insufficiency. It offers a rapid, office-based therapy with minimal patient downtime and an easier recovery than traditional surgical treatment. EVLT is effective and durable and can successfully treat saphenous truncal insufficiency and accessory branches with low complication rates. EVLT can increase patient satisfaction and enable the treatment of a wider variety of patients with a more efficient procedure compared with traditional techniques.     

剥脱联合腔内激光治疗大隐静脉曲张

目的:探讨剥脱术联合腔内激光治疗大隐静脉曲张的疗效.方法:回顾性分析2006年4月-2009年3月采用大隐静脉的大腿段剥脱联合小腿段激光腔内治疗的128例患者(176条肢体)的临床资料.结果:全组患者手术效果满意,症状缓解率100％,无伤口感染、下肢深静脉血栓形成等.近期并发症为胫前皮下淤血或小血肿12肢(6.8％),皮肤条状烧伤2肢(1.1％),浅静脉周围炎12肢(6.8％),踝部水肿2肢(1.1％);无胫前麻木感,无远期严重并发症;3年内无静脉曲张复发.结论:剥脱术联合腔内激光治疗大隐静脉曲张疗效确切,并发症少,是安全可靠的微创治疗方法.     

Endovenous laser treatment for primary varicose veins

Venous insufficiency of the lower extremities is a highly prevalent condition. Successful treatment of superficial venous insufficiency will most often necessitate treatment of the saphenofemoral junction incompetence with correction of saphenous vein reflux. In the majority of patients it concerns a reflux of the greater saphenous vein. The standard procedure consists of ligation and stripping of the greater saphenous vein combined with with additional phlebec-tomies or ligation of insufficient perforant veins if necessary. Although the standard procedure is widely known and accepted, the postoperative morbidity and postoperative limitations of activity are high. In this context minimally invasive percutaneous endovenous techniques were developed to improve the patients comfort and faster resumption of work. Among these, endovenous laser ablation of the greater saphenous vein is a relatively new procedure. Percutaneous introduction of a laser fiber into the incompetent vein and ablation with pulsed laser energy is far less invasive than stripping.     

腔内钬激光治疗下肢静脉曲张

目的探讨腔内钬激光治疗下肢静脉曲张的操作要点、技术优势、临床效果及作用机理。方法对96例下肢静脉曲张患者(99条肢体)采用600μm钬激光光纤,通过介入方法进行腔内钬激光大隐静脉闭合术。患者术前、中、后进行多普勒超声检查。记录手术时间;观察临床效果及并发症。平均随访时间7个月。结果67条(68％)大隐静脉在术中即刻闭合,术后1周内99条大隐静脉全部闭塞。随访期内多普勒超声检查无血管再通现象。无创口感染。2例患者有轻度皮肤灼伤。1例患者隐神经损伤。3例患者有大腿瘀斑。结论腔内钬激光治疗下肢静脉曲张的临床初步结果满意,具有美观、简便、微创的特点。     

Endovenous laser treatment for primary varicose veins

Venous insufficiency of the lower extremities is a highly prevalent condition. Successful treatment of superficial venous insufficiency will most often necessitate treatment of the saphenofemoral junction incompetence with correction of saphenous vein reflux. In the majority of patients it concerns a reflux of the greater saphenous vein. The standard procedure consists of ligation and stripping of the greater saphenous vein combined with with additional phlebectomies or ligation of insufficient perforant veins if necessary. Although the standard procedure is widely known and accepted, the postoperative morbidity and postoperative limitations of activity are high. In this context minimally invasive percutaneous endovenous techniques were developed to improve the patients comfort and faster resumption of work. Among these, endovenous laser ablation of the greater saphenous vein is a relatively new procedure. Percutaneous introduction of a laser fiber into the incompetent vein and ablation with pulsed laser energy is far less invasive than stripping.     

Endovenous radiofrequency ablation for the treatment of varicose veins

Chronic venous insufficiency (CVI) is the most common vascular disease and represents a significant health care problem in the United States. Reflux of the great saphenous vein is the most common cause of this condition, whose symptoms include varicose veins, leg swelling, skin discoloration, and ulceration. The traditional treatment of this condition is saphenofemoral ligation with stripping of the saphenous vein followed by varicose vein removal, if necessary. Recent advances in minimally invasive endovenous therapy have led to the development of catheter-based radiofrequency ablation (RFA) of the saphenous vein, which has gained an increasing acceptance in clinical practice. Endovenous RFA was introduced into clinical practice in Europe in 1998 and in the United States in 1999. Since then, over 250,000 procedures have been performed worldwide. Procedure safety and efficacy are well understood, with over 60 publications on the subject in the peer review literature, including four randomized trials comparing this technology with traditional vein stripping surgery. With the advent of tumescent anesthesia, the majority of RFA procedures are now performed in an office setting. This article examines the current technology using RFA in saphenous vein ablation with the Closure catheter system. Procedural techniques and clinical outcome using RFA in saphenous vein ablation are discussed. Clinical data comparing RFA versus saphenous vein stripping are also examined. Lastly, the clinical utility of a new RFA catheter, ClosureFAST, is discussed. ClosureFAST is a new generation of RFA catheter and has exhibited significant improvement in the ease of use and the procedure speed over the previous generation catheters while maintaining the favorable patient recovery profile seen with the RFA technology.     

Endovenous laser ablation of varicose veins: review of current technologies and clinical outcome

Symptomatic lower extremity varicose veins represent one of the most common vascular conditions in the adult population. Associated symptoms ranged from mild conditions such as fatigue, heaviness, and itching to more serious conditions such as skin discoloration and leg ulceration. The predominant causative factor of this condition is reflux of the great saphenous vein (GSV), which is traditionally treated with surgical saphenofemoral ligation and stripping of the incompetent saphenous vein. In recent years, there have been significant advances in saphenous vein ablation using percutaneous techniques, including the endovenous laser therapy (EVLT). In this article, the authors discuss the therapeutic evolution of this technology, theoretical basis of laser energy in GSV ablation, and procedural techniques of EVLT using duplex ultrasonography. Additional discussion of procedural-related complications, such as deep vein thrombosis, skin burn, saphenous nerve injury, and phletibis, and ecchymosis, are provided. Lastly, clinical results of EVLT in GSV ablation are discussed. Current literatures support EVLT as a safe and effective treatment option for varicosities caused by GSV incompetence.     

静脉腔内激光治疗下肢静脉曲张的疗效观察

目的　评价静脉腔内激光治疗下肢静脉曲张的疗效。方法　 46例患者共 5 4条患肢行单纯激光治疗或大隐静脉高位结扎加激光治疗。结果　所有患者的静脉曲张均闭塞。 19.5 %患者出现肢体淤斑 ,81.5 %患者肢体发生沿大隐静脉行程条索状硬结或硬块 ,11.1%患者皮肤局部麻木 ,1例患者发生皮肤浅表烧伤。所有患者均获随访 ,平均随访 6个月 (3～ 8个月 ) ,均痊愈。无深静脉血栓 ,无局部复发 ,疗效满意。结论　静脉腔内激光治疗是一种安全、有效、微创的治疗方法 ,选择大隐静脉高位结扎加激光治疗则更安全。     

Endovenous laser photocoagulation (EVLP) for varicose veins

BACKGROUND AND OBJECTIVES: Untreated varicose veins have significant morbidity and potential mortality. Treatment aims to relieve symptoms, improve appearance, and to prevent deterioration. Current therapeutic options include graduated compression stockings, sclerotherapy, ambulatory phlebectomy, surgical ligation, and stripping. Results of laser photocoagulation of vascular anomalies have been encouraging. Applying these concepts of laser-tissue interactions, we developed a new method of treatment for varicose veins of the lower extremities. STUDY DESIGN/MATERIALS AND METHODS: One hundred and forty-nine patients with 252 varicose greater saphenous veins underwent endovenous laser photocoagulation (EVLP) from January 1996 to January 2000. Subject's age ranged between 23 years 9 months and 80 years 7 months with a mean age of 50 years 8 months. There were 122 females and 27 males. Only patients with primary varicose veins and saphenofemoral reflux documented by Duplex ultrasound were treated. All patients received surgical ligation of the saphenofemoral junction (SFJ). EVLP was performed using the neodymium:yttrium-aluminium-garnet (Nd:YAG) (1,064 nm) laser, delivered with a 600 microm optical fiber. Laser power was set at 10 or 15 W, delivered with a pulse duration of 10 seconds. The outcome was compared before and after EVLP, based on the score of severity of the varicose veins by Hach's classification. RESULTS: The range of total delivered energy is from 9,200 to 20,100 J. The entire procedure was completed in 95-175 minutes (mean 122.33 minutes) for bilateral procedures, and 65-100 minutes (mean 81.07 minutes) for unilateral procedures. The follow-up period ranged from 12 to 28 months with a mean of 19 months. One hundred and forty-one patients with 244 legs involved (96.8%) demonstrated remarkable improvement (P < 0.05). Common early complications of EVLP are: local paraesthesia of the treated area in 92 legs (36.5%), ecchymosis and dyschromia in 58 legs (23.0%), superficial burn injury in 12 legs (4.8%), superficial phlebitis in four legs (1.6%), and localized hematoma in two legs (0.8%) at 3 weeks post-operatively. The final outcome showed no significant morbidity or mortality. All patients recovered completely. CONCLUSIONS: EVLP is a simple effective treatment modality for varicose veins. This less invasive method can minimize the complications of conventional surgery.     

Endovenous laser ablation of saphenous vein is an effective treatment modality for lower extremity varicose veins

We present our first experiences with the use of a new minimally invasive treatment of lower extremity varicose veins. We studied the occlusion rates of the great saphenous vein (GSV) with laser ablation, its failure rates, and its complications. Sixty-six limbs in 62 consecutive patients were treated and followed-up for 1 year. All of the patients had incompetent GSV proven by means of duplex scanning. The GSV segment from 2 cm distal to the sapheno-femoral junction to just above the knee was ablated by using laser energy. In addition, all patients had stab avulsions of the varicose veins of the leg with Crochet hooks. All patients were followed postoperatively on the 3rd day, 1 month, 3 months, and 1 year after surgery. All patients were treated as day-case surgeries. Among 62 patients studied, 46 patients were women (74%) and 16 were men (26%). The median age of the patients was 53 years (range 28-69 years). Median operation time was 65 min (range 40-140 min). Successful treatment (total obliteration of the GSV on duplex) was accomplished in 64 of 66 limbs (97%). In two cases, recanalization of the lower one-third of the treated segment of the GSV was noted after 3 months. There were no instances of neuropathy or skin burn. Endovenous laser ablation of varicose veins is effective in inducing thrombotic vessel occlusion and is associated with only minor adverse effects. The procedure seems to be a promising alternative for surgical stripping of the GSV.     

Endovenous ablation of the great saphenous vein may avert phlebectomy for branch varicose veins

BACKGROUND: Endovenous ablation of the great saphenous vein (GSV) may be performed simultaneously with stab phlebectomy of branch varicose veins or as a stand-alone procedure. A clinical approach of performing radiofrequency ablation (RFA) alone as initial treatment for varicose veins was reviewed. METHODS: Patients with duplex ultrasound-documented reflux in the GSV and CEAP clinical stage 2 to 6 were selected for RFA. Patients were examined within a week preoperatively with duplex ultrasound imaging. Patients were seen within a week postoperatively and again at 2 to 3 months to ascertain if further treatment was required. A retrospective review of the initial 184 procedures in a series from June 2002 through February 2005 was performed, allowing for a 9-month follow-up period. RESULTS: Three procedures were performed under general anesthesia and 181 with intravenous sedation and tumescent anesthesia. Postoperative duplex scans showed total occlusion or partial patency of <10 cm in 155 limbs. Seven (4.5%) had concomitant stab phlebectomy, seven subsequently had sclerotherapy, and 39 (25.2%) underwent subsequent stab phlebectomy of persistent symptomatic varicosities. In 101 limbs (65.1%), symptoms resolved and had no further therapy, and 24 limbs had a GSV that was patent for >10 cm on postoperative duplex imaging. Nine limbs had no further therapy (37.5%), eight (33.3%) had subsequent stab phlebectomy, and three had stripping of the GSV and stab phlebectomy. Four limbs had a redo RFA, four limbs had an aborted RFA procedure, and one limb was lost to follow-up. Failure of total GSV occlusion was more often associated with use of a 6F catheter. Complications were generally mild, and there was no postoperative deep vein thrombosis. CONCLUSION: Endovenous ablation of the GSV can be performed safely and effectively as the initial treatment for lower extremity varicose veins. Because most patients show clinical improvement after RFA, an algorithm of reassessment of the limb and branch varicose veins several months post-RFA allows most patients to defer stab phlebectomy.     

腔内激光治疗下肢原发性静脉曲张62例

目的总结原发性下肢静脉曲张患者行腔内激光治疗的经验和效果。方法62例下肢原发性静脉曲张患者均采用二极管激光仪行腔内激光治疗。激光治疗功率为10～12W,激光脉冲持续时间为1s,间隔时间为1s,逐渐退出静脉腔。结果随访时间为2～8个月。全部患者的曲张静脉消失,水肿消退,无坠胀感,无搔痒,无需用吗啡类镇痛药,无严重并发症。结论腔内激光治疗下肢原发性静脉曲张安全,效果满意。     

腔内激光治疗大隐静脉曲张192例报告

目的 探讨腔内激光治疗大隐静脉曲张的疗效。方法 2004年7月～2006年3月我院对192例238条肢体大隐静脉曲张行高位结扎、激光烧灼静脉主干和小腿曲张静脉。小腿局部严重曲张的静脉团,另做切口做局部切除或点状抽拨。结果 本组一次治愈率96.2%（229/238）。9例9条肢体术后因仍有少量曲张静脉存在,局麻下行切除或再次激光治愈。114例大隐静脉主干及小腿局部条索状硬结、疼痛;9例皮肤灼伤。术后住院时间4～8 d,平均5.6 d。158例随访1～18个月,平均11.6月,未见复发。结论 腔内激光治疗大隐静脉曲张效果确切,创伤小。     

Endovenous and surgical extirpation of lower-extremity varicose veins

Lower-extremity varicose veins are a very prevalent problem in the United States and represent a common referral for treatment. Therapeutic options for patients with lower-extremity superficial venous insufficiency have expanded in recent years, thanks to technological advances. Correction of both primary and secondary varicose veins can now be accomplished with endovenous and other minimally invasive techniques that allow for increased periprocedural patient comfort, as well as allowing more-rapid resumption of work or leisure activities with lower complication profiles. This article describes the first author's preferences and practice incorporating newer techniques for treatment of superficial venous reflux and varicose veins in an outpatient venous practice.     

Optical-thermal mathematical model for endovenous laser ablation of varicose veins

Endovenous laser ablation (EVLA) is successfully used to treat varicose veins. However, the exact working mechanism is still not fully identified and the clinical procedure is not yet standardized. Mathematical modeling of EVLA could strongly improve our understanding of the influence of the various EVLA processes. The aim of this study is to combine Mordon's optical-thermal model with the presence of a strongly absorbing carbonized blood layer on the fiber tip. The model anatomy includes a cylindrically symmetric blood vessel surrounded by an infinite homogenous perivenous tissue. The optical fiber is located in the center of the vessel and is withdrawn with a pullback velocity. The fiber tip includes a small layer of strongly absorbing material, representing the layer of carbonized blood, which absorbs 45 % of the emitted laser power. Heat transfer due to boiling bubbles is taken into account by increasing the heat conduction coefficient by a factor of 200 for temperatures above 95 °C. The temperature distribution in the blood, vessel wall, and surrounding medium is calculated from a numerical solution of the bioheat equation. The simulations were performed in MATLAB? and validated with the aid of an analytical solution. The simulations showed, first, that laser wavelength did virtually not influence the simulated temperature profiles in blood and vessel wall, and, second, that temperatures of the carbonized blood layer varied slightly, from 952 to 1,104 °C. Our improved mathematical optical-thermal EVLA model confirmed previous predictions and experimental outcomes that laser wavelength is not an important EVLA parameter and that the fiber tip reaches exceedingly high temperatures.     

Endovenous therapy for varicose veins of the lower extremities

Endovenous treatment for varicose veins of the lower extremities is an old technique. New technologies such as radiofrequency and laser have revived its indications. Thermal energy which is delivered to the vein wall results in a fibrous retraction and eventually complete obstruction of the vessel.