Annals of vascular surgery 2017 06 21() pii S0890-5096(16)31280-8
Varices and venous insufficiency are common and serious health problems in the general population which affect quality of life. Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux, and the endovenous laser ablation (EVLA) method has been widely accepted all over the world. In this method, ablation is provided by a laser fiber inserted into the lumen of the vein. Initially, the fibers were 810 nm, but today the fibers are usually 940, 980, or 1470 nm.
The study included 400 patients (419 procedures) who were diagnosed with venous insufficiency and underwent 980 nm and 1470 nm ELVA. Patients were followed-up for 48 months. A 980 nm bare-tip laser catheter in Group A and a 1470 nm radial-tip laser catheter in Group B were inserted until they were 2 cm below the saphenofemoral junction. An EVLA catheter was drawn slowly at the rate of 1-3 (2.08 ± 0.6) cm/s. The energy applied to the saphenous vein was 60-120 J/cm (84.65 ± 13.03) and 45-120 J/cm (76.95 ± 15.06) in Group A and Group B, respectively (p< 0.001), with 15 watts in the continuous mode. Follow-up visits included a physical examination and Doppler ultrasonography (USG) performed at the following time points: Day 1, week 1, and months 1, 6, 12, 24, 36, and 48. Saphenous vein occlusion rates and post-procedure saphenous vein diameters were evaluated at each follow-up visit. Pain levels were evaluated using the Wong-Baker FACES® pain scale (0-10). Postoperative complications were recorded. RESULTS
Group A (980 nm laser) consisted of 200 patients with a mean age of 37.84 ± 12.2 years. Group B (1470 nm laser) consisted of 200 patients with a mean age of 38.38 ± 12.1 years.The mean duration of the procedure was 32.2 ± 9.7 min in Group A and 31.7 ± 8.8 min in Group B, respectively (p = 0.47). Induration, ecchymosis, and paresthesia rates were significantly higher in the bare-tip laser group. The most important complication, deep vein thrombosis (DVT), was observed in four patients in Group A. Recanalization rates were found to be increased by prolonged follow-up periods. At the 48 month follow-up, this rate was 15.9% in Group A and 8.3% in Group B (p= 0.017). This rate showed that the 1470 nm wavelength laser treatment was more successful in Group B than in Group A over the long term.
Both the 980 nm and 1470 nm wavelength laser assisted EVLA procedures appear to be effective in treating saphenous vein insufficiency. The 1470 nm radial-tip fiber is preferred due to lower energy levels, lower complication rates, early return to daily life, and the successful long-term occlusion rate.