Endovenous Laser Treatment of the Small Saphenous Vein with a 980-nm Diode Laser: Early Results

BACKGROUND Whereas numerous studies have been conducted regarding the outcome of the treatment of the great saphenous vein, few studies have been conducted on the small saphenous vein (SSV), especially concerning endovenous laser treatment.
OBJECTIVE The objective was to evaluate the safety and efficacy of the 980-nm diode laser for the treatment of SSV reflux caused by saphenopopliteal junction (SPJ) incompetence.
MATERIALS AND METHODS From October 2003 to April 2006, 390 SSVs in 344 subjects with varicose veins were treated with 980-nm diode laser energy delivered percutaneously into the SSV. Tumescent anesthesia (70–220 mL of 0.1% lidocaine) was delivered perivenously under ultrasound (US) guidance. The patients were evaluated clinically and with duplex US at 1 week, 1 month, 3 months, 6 months, 1 year, and thereafter to assess the efficacy of the treatment and the adverse reactions of the patients to it.
RESULTS Successful occlusion of the SSV, defined as the absence of flow on color Doppler imaging, was noted in 389 of the 390 SSVs (99.7%) after the initial treatment. The remaining 1 SSV was closed after the repeat treatment. Of 108 SSVs, 102 (94.4%) remained closed throughout the 12th-month follow-up. Bruising and tightness along the course of the treated vein was present in almost all the patients, but these disappeared in 1 to 2 weeks. Seven patients (2%) noted localized skin paresthesia, but there were no major complications like skin burns and deep vein thrombosis.
CONCLUSION Taking into account the high failure rates of incompetent SSV surgery and the anatomic complexity of SPJ, the endovenous 980-nm diode laser surgery is a safe and effective, cosmetically preferential procedure while a long-term follow-up is being awaited.     

Endovenous Laser Treatment of the Lesser Saphenous Vein With a 940-nm Diode Laser: Early Results

BACKGROUND: Until now, endovenous laser treatment (ELT) of the lesser saphenous vein (LSV) has not been reported. OBJECTIVE: To evaluate efficacy and side effects for ELT of the LSV. METHOD: Otherwise unselected patients with an incompetent LSV were included. After perivenous infiltration of tumescent local anesthesia, laser energy (940 nm) was administered endovenously, either in a pulsed fashion or continuously during constant backpull of the laser fiber. Patients were scheduled for duplex follow-up at Day 1 and also at 1, 3, 6 and 12 months, postoperatively. RESULTS: Forty-one LSVs were targeted in 33 patients with a median age of 66 years (range, 35 to 93). Seventy-three percent of patients had skin changes (C4). Thirty-six percent had an open or healed venous ulcer (C5,6) and 15% a postthrombotic syndrome (ES AS,D PR). Thirty-nine LSVs (95%) completed ELT successfully. During a median follow-up interval of 6 months (range, 3 to 12 months), no recanalization event could be observed. Apart from one thrombosis of the popliteal vein in a patient with polycythemia vera, only minor side effects, particularly no permanent paresthesia, could be observed. CONCLUSION: ELT of the LSV under tumescent local anesthesia is feasible and effective. Caution is warranted with ELT of thrombophilic patients.     

Incompetent Great Saphenous Veins Treated with Endovenous 1,320-nm Laser: Results for 71 Legs and Morphologic Evolvement Study

BACKGROUND: Endovenous lasers with various wavelengths have been utilized with good outcomes in treating leg varicose veins. The natural history and evolution of treated veins after endovenous procedures, however, have seldom been addressed. OBJECTIVE: This study determines the efficacy vein ablation and serial venous morphologic evolution of incompetent great saphenous veins (GSVs) after endovenous 1,320-nm laser treatment. METHODS: Fifty patients with symptomatic varicose veins secondary to GSV insufficiency treated with 1,320-nm endovenous laser ablation were enrolled. The treated varicose veins in each limb were mapped and sized before laser treatment. Vein wall diameters were measured with duplex ultrasound at follow-up visits. RESULTS: Seventy-one limbs in 50 patients were enrolled. During the mean 13.1-month follow-up, closure of GSVs was observed in 94% of limbs (67/71). Vein diameters at 3 cm below saphenofemoral junction level were reduced to 81% at 2 days, 75% at 1 month, 48% at 3 months, and 39% at 5 months. Average mean duration for treated GSVs to narrow as fibrotic cords (internal diameter,<2.5 mm) was 5.8 months. CONCLUSION: The endovenous 1,320-nm laser ablation procedures have excellent efficacy in treating incompetent GSVs. This excellent shrinkage behavior may be the basis for nice long-term results of patients treated with 1,320-nm Cooltouch endovenous laser.     

Early Results and Feasibility of Incompetent Perforator Vein Ablation by Endovenous Laser Treatment

BACKGROUND Dissection of incompetent perforator veins even when using the subfascial endoscopic perforator surgery technique is associated with substantial side effects.
OBJECTIVE The objective was to evaluate the feasibility of endovenous laser ablation of incompetent perforator veins.
PATIENTS AND METHODS A 940-nm diode laser and a Nd:YAG laser with 1,320 nm were used with laser fibers of 600 μm diameter. Perforators were accessed by ultrasound-guided puncture using 16- and 18-gauge cannulas, respectively. Fiber tips were placed below the fascia with at least 1-cm distance from the deep vein system. After administration of perivascular local anesthesia, laser energy was delivered in a pulsed fashion using laser power in the range between 5 and 30 W.
RESULTS A total of 67 perforators were treated. Except one vein, all others were occluded at Day 1 after treatment. With 1,320 nm at 10 W, a median of 250 J (range, 103–443 J) was delivered resulting in significantly reduced posttreatment diameters to a mean of 69±23% ( p =.0005). With 940 nm at 30 W, a median of 290 J (range, 90–625 J) was administered, showing no significant posttreatment diameter reduction. Side effects were moderate.
CONCLUSION Ultrasound-guided endovenous ablation of incompetent perforators is safe and feasible.     

Sebaceous Hyperplasia Treated With a 1450-nm Diode Laser

Background. Sebaceous hyperplasia is a benign proliferation of the sebaceous gland. Previous treatment options have included isotretinoin, destructive modalities, and pulsed-dye laser.
Objective. To evaluate the efficacy of a 1450-nm diode laser for the treatment of sebaceous hyperplasia.
Methods. Ten patients with sebaceous hyperplasia were treated one to five times with a 1450-nm diode laser. Fluences of 16 to 17 J/cm² were used, with cooling durations of 40 to 50 ms. Patients and physicians evaluated treated lesions for improvement. Measured areas of treated lesions were also recorded.
Results. In most cases, patients and physicians rated improvement as "very good" or better. After two to three treatments, 84% of lesions shrunk greater than 50%, and 70% shrunk greater than 75%. Adverse effects were unusual; one atrophic scar and one case of transient hyperpigmentation were observed.
Conclusion. The 1450-nm diode laser is effective and safe for the treatment of sebaceous hyperplasia.     

Endovenous Treatment of the Great Saphenous Vein Using a 1,320 nm Nd:YAG Laser Causes Fewer Side Effects than Using a 940 nm Diode Laser

BACKGROUND: Limited data are available about treatment-related side effects with respect to laser wavelength in endovenous laser treatment (ELT) of the great saphenous vein (GSV). OBJECTIVE: To compare the results and side effects of a 940 nm diode and a 1,320 nm neodymium:yttium-aluminum-garnet (Nd:YAG) laser. METHODS: Three patient cohorts (A, B, and C) received ELT of the GSV using a 940 nm diode laser at 15 W (group A) or 30 W (group B) or using a 1,320 nm laser at 8 W (group C). In all cases, energy was administered continuously with constant pullback of the laser fiber under perivenous tumescent local anesthesia. RESULTS: The GSVs of group A (n = 113), group B (n = 136), and group C (n = 33) received ELT. An average linear endovenous energy density of 24, 63, and 62 J/cm and an average endovenous fluence equivalent of 12, 30, and 33 J/cm2 were administered to the vein. Occlusion rates were 95% (group A), 100% (group B), and 100% (group C) at day 1 after ELT and 90.3% (group A), 100% (group B), and 97% (group C) at 3 months after ELT. With the 1,320 nm laser ELT (group C), treatment-related pain (50%) and the need for analgesics (36%) were significantly reduced (p < .005) in comparison with treatment-related pain (81%) and the need for analgesics (67%) after the 30 W 940 nm laser ELT (group B). Ecchymosis was also significantly reduced (p < .05) in group C (1,320 nm) compared with group B (30 W, 940 nm). CONCLUSION: ELT of the GSV using a 1,320 nm Nd:YAG laser causes fewer side effects compared with 940 nm diode laser ELT.     

Lipolysis Using a 980-nm Diode Laser: A Retrospective Analysis of 534 Procedures

Background  The safety and efficacy of the 980-nm diode laser for laser lipolysis were evaluated in different body areas. Methods  From June 2005 to June 2007, 334 subjects underwent laser lipolysis. The treatment was performed using a 980-nm diode laser (OSYRIS, Hellemmes, France). After tumescent anesthesia, a 1-mm-diameter microcannula housing a 600-μm optical fiber was inserted into the subcutaneous fat. The cannula was moved back and forth in a predetermined manner to get a homogeneous distribution of energy at the treated area. Laser settings (power and cumulative energy) were selected in relation to individual body areas: 6 W (chin, arm, knee), 10 W (abdomen, back), and 15 W (thigh, hips, buttock). Patient satisfaction was evaluated and side effects were recorded. The laser energy counter incrementally counted the energy used; then the cumulative energy used for each treatment was recorded. Ultrasound imaging was used to control tumescent anesthesia infiltration, cannula position prior to laser emission,and postoperative fat liquefaction. Results  Five hundred thirty-four (534) laser lipolysis procedures were performed on 334 patients. Different areas were treated: hips (197), inner thighs (86), abdomen (86), knees (61), flanks (57), buttocks (28), chin (22), arms (18), back (4). Mean cumulative energy was area–dependent, ranging from a minimum of 2200 J (knee) to a maximum of 51,000 J (abdomen). Contour correction and skin retraction were observed almost immediately in most patients. There was no scarring, infection, burns, hypopigmentation, bruising, swelling, or edema. Ecchymoses were observed in almost all patients but resolved in under 1 week for 322 patients. Patient satisfaction was very high. Because laser lipolysis is an outpatient procedure, patients were able to resume normal daily activities after 24 h. Ultrasound imaging confirmed that the thermal effect generated by the laser results in melting and rupture of the collagenous and subdermal bands. Conclusion  This clinical study demonstrates that the removal of small volumes of fat with concurrent subdermal tissue contraction can be performed safely and effectively using a 980-nm diode laser. Additional benefits include excellent patient tolerance and quick recovery time. This study also confirms that enough accumulated energy must be delivered to achieve sufficient lipolysis throughout different fat layers.     

Nonocclusion and Early Reopening of the Great Saphenous Vein After Endovenous Laser Treatment Is Fluence Dependent

Background. Parameters influencing failure and recanalization rates of endovenous laser treatment (ELT) of the great saphenous vein (GSV) are still to be determined.
Objective. To evaluate treatment-related parameters of ELT with respect to early failure of occlusion or recanalization of GSVs.
Methods. A series of 77 consecutive patients received ELT of 106 GSVs with continuous pullback of the laser fiber. Duplex examination was performed at 1 day, 4 weeks, and 3 months after the procedure. Clinical patient and vessel characteristics as well as technical parameters of the ELT procedure were evaluated via multiple logistic regression analysis.
Results. A median vein length of 60 cm (range of 18 to 90) was treated with a median pullback velocity of 0.6 cm/sec (range of 0.4 to 1.3), resulting in a median energy delivery of 23.4 J/cm (range of 11.8 to 35.5) and a median laser fluence of 11.8 J/cm² (range of 2.8 to 37.3). At day 1 after ELT, 6 GSVs (6%) were not occluded. At 1 and 3 months after ELT, 9 GSVs (9%) and 11 GSVs (10%), respectively, were found open by color duplex examination. Risk factors for nonocclusion 3 months after ELT, by univariate analysis, were laser fluence, laser energy per centimeter of vein length, diameter of the vein before treatment, and distance of the thrombus to the sapheno-femoral junction at day 1 after treatment. Finally, multiple regression analysis selected laser fluence (p=0.004, odds ratio=0.40 J/cm²) as the relevant risk factor for ELT failure or recanalization.
Conclusion. ELT failure seems to be related to the administration of low laser fluences.