Laser saphenous ablation results with at least one year of follow-up

Year 2012, Volume: 39 Issue: 4, 474 - 478, 01.12.2012

Mehmet Erdem Memetoğlu Ozan Erbasan

https://doi.org/10.5798/diclemedj.0921.2012.04.0185

Abstract

Objectives: This retrospective study aimed to evaluate the efficacy and durability of endovenous laser ablation with 940 nanometer wavelength with at least one-year follow-up. Materials and methods: Between December 2009 and February 2012, a total of 68 incompetent great saphenous veins and 4 small saphenous veins were treated by endovenous laser ablation, using 940 nanometer wavelengths. Patients underwent standard clinical and duplex follow-up examinations with a mean of 18 months (range 12 to 26 months) after endovenous laser ablation. Patient satisfaction regarding the procedure was assessed with the use of a visual analog scale (range 1 to 100). Results: Post-procedural duplex scans showed total occlusion of the treated great saphenous veins in 56 patients (97%) and sub-total occlusion in 2 (3%) patients. For small saphenous veins, post-procedural duplex scans showed total occlusion in 4 (100%) patients. The average pre-procedure modified clinical picture, etiology, anatomic distribution and pathophysiology clinical score improved significantly after 12 months. Complications from our series included swelling and induration in 3 patients (5%), skin pigmentation in 3 patients (5%). Patient satisfaction with the surgical outcome was 83.17 % (±11.79, n=58). Conclusions: Our results have been satisfying, and this study has reaffirmed the effectiveness and durability of endovenous laser ablation with 940 wavelength in the treatment of great saphenous vein insufficiency.

Keywords

Duplex ultrasound, endovenous technique, saphenous vein, venous insufficiency

En az bir yıl takipleriyle birlikte lazer safen ablasyon sonuçlarımız

Abstract

Amaç: Bu retrospektif çalışma, 940 nanometre dalga boyu ile endovenöz lazer ablasyonun etkinlik ve kalıcılığını, en az 1 yıllık takibiyle birlikte değerlendirmeyi amaçlamıştır. Gereç ve yöntem: Aralık 2009 ve Şubat 2012 arasında, inkompetan 68 büyük safen ven ve 4 küçük safen ven, 940 nanometre dalga boyu kullanarak, endovenöz lazer ablasyonla tedavi edildi. Hastaların, endovenöz lazer ablasyonu sonrası ortalama 18 ay (aralığı 12 ile 26 ay) ile standart klinik ve dupleks muayeneleri yapıldı. Prosedür ile ilgili hasta memnuniyeti, görsel analog skala kullanımı (aralığı 1 ila 100) ile değerlendirildi. Bulgular: İşlem sonrası dupleks taramalarda, büyük safen veninin 56 (%97) hastada total okluzyonu ve 2 (%3) hastada sub-total okluzyonu tespit edildi. İşlem sonrası dupleks taramalarla, küçük safen ven için 4 (100%) hastada total okluzyon tespit edildi. İşlem öncesi ortalama modifiye klinik tablo, etyoloji, anatomik dağılım ve patofizyoloji klinik skor, 12 ay sonra önemli ölçüde düzeldi. Serimizin komplikasyonları olarak, 3 (%5) hastada şişme ve endurasyon; 3 (%5) hastada cilt pigmentasyonu görüldü. Cerrahi sonuçla ilgili hasta memnuniyeti 83,17 % (±11,79, n=58) bulundu. Sonuç: Sonuçlarımız tatmin edicidir ve bu çalışma, büyük safen ven yetmezliği tedavisinde 940 dalga boyu ile endovenöz lazer ablasyon etkinliğini ve kalıcılığını teyit etmiştir.

Keywords

Dupleks ultrason, endovenöz teknik, safen ven, venöz yetmezlik

References

• Robertson L, Evans C, Fowkes FG. Epidemiology of chronic venous disease. Phlebology 2008;23(3):103-11.
• Somers P, Knaapen M. The histopathology of varicose vein dis- ease. Angiology 2006;57(5): 546-55.
• Rigby KA, Palfreyman SJ, Beverley C et al. Surgery versus sclerotherapy for the treatment of varicose veins. Cochrane Database Syst Rev 2004;18(4):CD004980.
• van Rij AM, Jiang P, Solomon C, Christie RA, Hill GB. Re- currence after varicose vein surgery: a prospective long-term clinical study with duplex ultrasound scanning and air plethys- mography. J Vasc Surg 2003;38(5):935-43.
• Durai R, Srodon PD, Kyriakides C. Endovenous laser abla- tion for superficial venous insufficiency. Int J Clin Pract 2010;64(1):61-6.
• Fan CM, Rox-Anderson R. Endovenous laser ablation: mecha- nism of action. Phlebology 2008;23(5):206-13.
• Tan KK, Nalachandran S, Chia KH. Endovenous laser treatment for varicose veins in Singapore: a single centre experience of 169 patients over two years. Singapore Med J 2009;50(6):591-4.
• Bos R, Arends L, Kockaert M et al. Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg 2009;49(1):230-9.
• Lurie F, Creton D, Eklof B, et al. Prospective randomised study of endovenous radiofrequency obliteration (closure) versus li- gation and vein stripping (EVOLVeS): two-year follow-up. Eur J Vasc Endovasc Surg 2005;29(1):67-73.
• van Groenendael L, Flinkenflögel L, van der Vliet JA, et al. Conventional surgery and endovenous laser ablation of recur- rent varicose veins of the small saphenous vein: a retrospec- tive clinical comparison and assessment of patient satisfaction. Phlebology 2010;25(3):151-7.
• Spreafico G, Kabnick L, Berland TL, et al. Laser saphenous ablations in more than 1,000 limbs with long-term duplex ex- amination follow-up. Ann Vasc Surg 2011;25(1):71-8.
• Ravi R, Trayler EA, Barrett DA, et al. Endovenous thermal ablation of superficial venous insufficiency of the lower ex- tremity: single-center experience with 3000 limbs treated in a 7-year period. J Endovasc Ther 2009;16(4):500-5.
• Goode SD, Chowdhury A, Crockett M, et al. Laser and radio- frequency ablation study (LARA study): a randomised study comparing radiofrequency ablation and endovenous laser abla- tion (810 nm). Eur J Vasc Endovasc Surg 2010;40(2):246-53.
• Ergenoglu MU, Sayin M, Kucukaksu S. Fate of vena saphe- na magna stump after endovenous laser ablation with 980- nm diode laser: 12-month follow-up. Photomed Laser Surg 2010;28(5):659-62.
• Proebstle TM, Herdemann S. Early results and feasibility of in- competent perforator vein ablation by endovenous laser treat- ment. Dermatol Surg 2007;33(2):162-8.
• Rathod J, Taori K, Joshi M, et al. Outcomes using a 1470-nm laser for symptomatic varicose veins. J Vasc Interv Radiol 2010;21(12):1835-40.
• Kabnick LS. Outcome of different endovenous laser wave- lengths for great saphenous vein ablation. J Vasc Surg 2006;43(1):88-93.
• Proebstle TM, Sandhofer M, Kargl A, et al. Thermal damage of the inner vein wall during endovenous laser treatment: key role of energy absorption by intravascular blood. Dermatol Surg 2002;28(7):596-600.
• Van Den Bos RR, Neumann M, De Roos KP, Nijsten T. En- dovenous laser ablation-induced complications: review of the literature and new cases. Dermatol Surg 2009;35(8):1206-14.
• Theivacumar NS, Dellagrammaticas D, Mavor AI, Gough MJ. Endovenous laser ablation:does standard above-knee great sa- phenous vein ablation provide optimum results in patients with both above- and below-knee reflux? A randomized controlled trial. J Vasc Surg 2008;48(1):173-8.