Middle-Term Results of 980 nm and 1470 nm Laser and Endovenosus Laser Ablation Theraphy in Lower Extremity Surface Venous Insufficiency Treatment

Year 2024, Volume: 19 Issue: 1, 49 - 55, 28.03.2024

Murat Arı Ahmet Büyük Orhan Bozoğlan Erdinç Eroğlu

https://doi.org/10.17517/ksutfd.1183421

Abstract

Objective: Superficial venous insufficiency of the lower extremities is a common disease that causes clinical symptoms and can extend to venous ulcers if left untreated. Surgery has been the primary treatment method for many years in the treatment of superficial venous insufficiency and varicose veins. Endovenous laser ablation (EVLA) is a safe and effective minimally invasive treatment method that has recently come to the fore in the treatment of saphenous vein insufficiency. In this study, we aimed to compare the effectiveness, complications, and early and mid-term results of EVLA treatments with different wavelength lasers.
Material and Methods: A hundred symptomatic superficial venous insufficiency patients who applied to Kahramanmaraş Sütçü İmam University Faculty of Medicine Cardiovascular Surgery outpatient clinic and had treatment indication and planned EVLA were included in the study. The patients were divided into two groups. 25 patients had bilateral disease, and a total of 125 lower extremities were treated. A 10W laser with a wavelength of 980 nm was applied to one group (Group 1), and a 10W laser with a wave length of 1470 nm (Group 2) was applied to the other group.
Results: In the 6th-month follow-up, complete occlusion continued in all of the 1470 nm laser-applied group, while recanalization was observed in 3 extremities (5%) of the 980 nm laser-applied patients. Venous clinical severity score (VCSS) and VAS scores were similar in both groups before the procedure. After the procedure, both VCSS (p=0,002) and VAS scores(p<0,001) were significantly lower in Group 2. Likewise, the time to return to daily activities (p<0,001) and the time to feel pain (p<0,001) were shorter in Group 2. While major complications were not seen in both groups, ecchymosis, paresthesia, induration, and analgesia requirement, which are considered minor complications, were less in Group 2 (p<0,0001, p<0,0001, p<0,0001, p<0,001 respectively).
Conclusion: In this study, it was determined that the high laser wavelength used in EVLA treatment was more effective and less postoperative side effects compared to lasers with low laser wavelengths.

Keywords

endovenous laser ablation, varicose ven, venous insuffiency

Alt Ekstremite Yüzeyel Venöz Yetmezlik Tedavisinde 980 nm ve 1470 nm Lazer ile Endovenöz Lazer Ablasyon Tedavisinin Orta Dönem Sonuçları

Abstract

Amaç: Alt ekstremite yüzeyel venöz yetmezlik klinik semptomlara neden olan tedavi edilmediğinde venöz ülserlere kadar uzanabilen ve toplumda sık görülen bir hastalıktır. Yüzeyel venöz yetmezlik ve varislerin tedavisinde uzun yıllardır primer tedavi yöntemi cerrahi tedavidir. Endovenöz lazer ablasyon (EVLA) safen ven yetmezliği tedavisinde, son dönemde ön plana çıkan güvenli ve efektif minimal invaziv tedavi yöntemidir. Bu çalışmamızda, farklı dalga boylu lazerler ile EVLA tedavilerinin etkinliğini, komplikasyonlarını, erken ve orta dönem sonuçlarını karşılaştırmayı amaçladık.
Gereçler ve Yöntemler: Çalışmaya Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Kliniği’ne başvuran, semptomatik yüzeyel venöz yetersizlik tanısı alan ve tedavi endikasyonu konup EVLA planlanan 100 kişi dahil edildi. Hastalar 2 gruba ayrıldı. 25 hastanın bilateral hastalığı mevcuttu, toplam 125 alt ekstremiteye tedavi uygulandı. Bir gruba 980 nm dalga boylu 10W gücünde lazer (Grup 1), diğer gruba ise 1470 nm dalga boylu 10W gücünde lazer (Grup 2) uygulandı.
Bulgular: 6.ay kontrolünde 1470 nm dalga boylu lazer uygulanan grubun tamamında tam oklüzyon devam ederken, 980 nm dalga boylu lazer uygulanan hastaların 3 ekstremitesinde (%5) rekanalizasyon izlendi. Venöz klinik şiddet skoru (VCSS) ve VAS skorları işlem öncesi her 2 grupta da benzerdi. İşlem sonrası Grup 2'de hem VCSS (p=0,002) hem de VAS skoru (p<0,001) anlamlı düşük saptandı. Aynı şekilde günlük aktiviteye dönme süresi (p<0,001) ve ağrı duyma süresi (p<0,001) Grup 2’de daha kısaydı. Her 2 grupta da majör komplikasyon görülmezken, minör komplikasyon olarak kabul edilen ekimoz, parestezi, endürasyon ve analjezi ihtiyacı Grup 2’de daha az (sırasıyla p<0,0001, p<0,0001, p<0,0001, p<0,001) görülmüştür.
Sonuç: Bu çalışmamızda EVLA tedavisinde kullanılan yüksek lazer dalga boyunun düşük lazer dalga boyuna sahip lazerlere kıyasla daha etkin ve daha az postoperatif yan etkilere yol açtığı saptanmıştır.

Keywords

endovenöz lazer ablasyon, variköz ven, venöz yetmezlik

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