Endovenous 1470 nm laser treatment of the saphenous vein: Early report of pain assessment

Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey - .
The Journal of cardiovascular surgery (Impact Factor: 1.46). 04/2013; 54(2):263-7.
Source: PubMed


The aim of the paper was to evaluate the rate of postoperative pain by using endovenous laser ablation with wave-length of 1470 nm for incompetent saphenous veins in our single center experience.

A non-randomized prospective trial was performed. Patients with symptomatic varicose small saphenous vein and great saphenous vein were considered suitable for endovenous laser ablation. The VenaCure EVLT™ (Angiodynamics, Queensbury, NY) generator was used to provide laser energy (1470 nm emission wavelength). Pain was assessed on the 7th days, 1st months, 3rd months, and 6th months using a visual analog scale rating of 0 cm (no pain) to 10 cm (worst imaginable pain).

Of the 30 patients who eventually underwent endovenous laser ablation, 14 underwent bilateral treatment. Totally, 44 treated legs were scored. When questioned by using a visual analog scale pain score of 0-10, patients, on average, graded their pain 3.86 ± 1.04 at admission, 2.83 ± 0.91 at 1 week, 1.46 ± 0.63 at 1 month, 0.63 ± 0.49 at 3 months, and 0.07 ± 0.25 at 6 months. No major complication occurred, and there was no deep venous thrombosis or pulmonary embolism nor skin ulceration.

Endovenous laser ablation for chronic venous insufficiency with a 1470-nm diode laser appears to be effective and safe. The procedure is simple to perform, well accepted by patients and relatively atraumatic.

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Available from: Irfan Celebi, Jan 30, 2015
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    ABSTRACT: Purpose: To demonstrate 1-year outcomes after low-energy endovenous laser ablation (EVLA) of incompetent saphenous veins with linear endovenous energy density (LEED) of 80 J/cm or lower with the use of a 1,470-nm diode laser. Materials and methods: Incompetent saphenous veins in 236 patients (355 limbs; Clinical/Etiology/Anatomy/Pathophysiology classifications of C2-C4) were treated by EVLA with a bare-tipped 1,470-nm laser with LEED no greater than 80 J/cm (mean, 72.4 J/cm) and laser power of 8-12 W. Patients were evaluated clinically and with duplex ultrasonography at 1 week and 1, 3, 6, and 12 months after EVLA to assess the technical and clinical success and complication rates. Results: In the 355 limbs, the technical success rate was 100%. The great saphenous vein (GSV) remained occluded in all 229 limbs (100%) after 1 week, 202 of 203 limbs (99.5%) after 1 month, 157 of 158 limbs after 3 months (99.3%), all 99 limbs after 6 months (100%), and all 41 limbs after 1 year (100%). The small saphenous vein (SSV) remained occluded in all 103 limbs (100%) after 1 week, all 94 limbs (100%) after 1 month, 68 of 69 limbs (98.5%) after 3 months, 40 of 41 limbs (97.5%) after 6 months, and all 14 limbs after 1 year (100%). Two GSVs and two SSVs were recanalized and underwent repeated EVLA. No major complications occurred, although bruising (21% of cases), pain (15%), and paresthesia (4%) were observed. Conclusions: Low-energy EVLA with the use of a 1,470-nm laser with LEED of 80 J/cm or lower is an effective, safe, and technically successful option for the treatment of incompetent saphenous veins.
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    ABSTRACT: The purpose of this study was to compare the effectiveness of 1470- and 980-nm lasers with regard to power output, complications, recanalization rates, and treatment response. We prospectively evaluated the effectiveness of endovenous laser ablation (EVLA) in a total of 152 great and small saphenous veins from 96 patients. Lasers were randomly used based on the availability of the units. Patients were clinically evaluated for Clinical Etiologic Anatomic Pathophysiologic (CEAP) stage and examined with Doppler ultrasound. Treatment response was determined anatomically by occlusion of the vein and clinically by the change in the venous clinical severity score (VCSS). Seventy-eight of the saphenous veins underwent EVLA with a 980-nm laser and 74 underwent EVLA with a 1470-nm laser. Treatment response was (68) 87.2 % in the 980-nm group and (74) 100 % in the 1470-nm group (p = 0.004). The median VCSS decreased from 4 to 2 in the 980-nm group (p < 0.001) and from 8 to 2 (p < 0.001) in the 1470-nm group. At 1-year follow-up, seven veins treated with 980 nm and two veins treated with 1470 nm were recanalized (p = 0.16); the average linear endovenous energy density (LEED) was 83.9 (r, 55-100) J/cm and 58.5 (r, 45-115) J/cm, respectively (p < 0.001). Postoperative minor complications occurred in 23 (29.4 %) limbs in the 980-nm group and in 19 (25.6 %) limbs of the 1470-nm group (p = 0.73). EVLA with the 1470-nm laser have less energy deposition for occlusion and better treatment response.
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