Endovenous heat-induced thrombosis after ablation with 1470 nm laser: Incidence, progression, and risk factors
(Impact Factor: 1.77).
03/2014; 30(5). DOI: 10.1177/0268355514526588
To evaluate the incidence of heat-induced thrombosis, its progression and risk factors that may contribute to its formation after endovenous laser ablation.
This was a prospective evaluation of all patients who had endovenous laser ablation of the great saphenous vein, accessory saphenous vein, and small saphenous vein using 1470 nm wavelength laser, from March 2010 to September 2011. All patients who developed endovenous heat-induced thrombosis at the saphenofemoral junction or at the saphenopopliteal junction were included. Demographic data, history of venous thrombosis, body mass index, vein diameter, reflux time, catheter tip position, endovenous heat-induced thrombosis progression, number of phlebectomies, and venous clinical severity scores were analyzed. Duplex ultrasound was done in all patients preoperatively, and 2-3 days postoperatively.
Endovenous laser ablation was performed in 2168 limbs. Fifty-seven percent had great saphenous vein, 13% accessory saphenous vein, and 30% small saphenous vein ablation. Endovenous heat-induced thrombosis was developed in 18 limbs (12 at saphenofemoral junction and six at saphenopopliteal junction) for an incidence of 0.9%. Eight were class 1 and 10 were > class 2. No pulmonary embolism was reported. The percentage of men with endovenous heat-induced thrombosis was higher compared to those without (39% vs. 24%, p = .14). The median age for endovenous heat-induced thrombosis patients was 59.6 compared to non-endovenous heat-induced thrombosis (p = .021). Great saphenous vein/accessory saphenous vein diameter for endovenous heat-induced thrombosis patients was 8.0 mm versus 6.3 mm for non-endovenous heat-induced thrombosis patients (p = .014), and for small saphenous vein it was 5.7 mm versus 4.5 mm (p = .16). Multiple concomitant phlebectomies were performed in 55.6% of the endovenous heat-induced thrombosis patients compared to 37% in non-endovenous heat-induced thrombosis (p = .001). All other parameters were similar between endovenous heat-induced thrombosis and non-endovenous heat-induced thrombosis group. Endovenous heat-induced thrombosis resolution occurred in 16 cases at 2-4 but two cases progressing from class 1 to 2, before resolution. The mean VCSS score for endovenous heat-induced thrombosis patients preoperatively was 5.6 and improved to 2.8 (p = .003) at one month.
Risk factors associated with endovenous heat-induced thrombosis formation after endovenous laser ablation include: vein size, age, and multiple phlebectomies. Endovenous heat-induced thrombosis resolves in 2-4 weeks in most patients but it may worsen in few.
Available from: Aykut RECEP Aktaş
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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.
Available from: Walter Jr. Boim Araujo
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Background: Water-specific 1470-nm lasers enable vein ablation at lower energy densities and with fewer side effects because they target interstitial water in the vessel wall. Objectives: To determine great saphenous vein (GSV) occlusion rate after thermal ablation with 1470-nm laser using 7W power and to evaluate clinical outcomes and complications. Method: Nineteen patients (31 GSVs) underwent thermal ablation. Follow-up duplex scanning, clinical evaluation using the Venous Clinical Severity Score (VCSS), and evaluation of procedure-related complications were performed at 3-5 days after the procedure and at 30 and 180 days. Results: Mean patient age was 46 years and 17 of the patients were female (89.47%). Of 31 limbs treated, 2 limbs were clinical class C2, 19 were C3, 9 were C4, and 1 limb was C5 according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. Mean linear endovenous energy density was 33.53 J/cm. The GSV occlusion rate was 93.5% immediately after treatment, 100% at 3-5 days and 100% at 30 days after treatment and 87.1% 180 days after treatment. There was a significant reduction in VCSS at all time points. Conclusions: The data from this study support the possibility that the incidence of complications can be reduced without significantly affecting the clinical outcomes, by using lower energy density. However, this appears to be at the cost of reduced efficacy in terms of GSV occlusion rates.
Keywords: ablation techniques; laser therapy; varicose veins.
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