Outcomes of endovenous laser ablation using a 1470-nm laser for the treatment of incompetent great saphenous veins: Real-world data

Abstract

This study aimed to show outcomes and side effects after endovenous laser ablation of incompetent great saphenous veins (GSV) with a 1470 nm Diode laser under real-world conditions. A before-after observational study was conducted on 814 patients (1089 lower limbs) with GSV who underwent endovenous laser ablation using 1470 nm from July 2016 to November 2022 at Cardiology Center, Military Hospital 103. The patients were assessed for disease severity using clinical, etiological, anatomical and pathological (CEAP) scores and venous clinical severity scores (VCSS). The Chronic Venous Insufficiency Quality of Life Questionnaire 20 (CIVIQ-20) pre- and post-operatively measured the quality of life. Patient-reported outcome measures were collected at follow-up one month after discharge. 814 cases with a mean age of 59.60 ± 13.49 years were studied (61.8% female). One month after laser ablation, patients with a CEAP clinical class C2 decreased significantly compared to the before (15.5% versus 52.3%; p <0.01, respectively). None of the patients with class C3 and C6 were observed. The VCSS and CIVIQ-20 scores after laser treatment decreased significantly compared to before (2.74 ± 1.79 versus 6.70 ± 2.37 and 24.59 ± 3.05 versus 35.90 ± 8.95; p <0.01). The common complications were ecchymoses (34.2%), induration (9.1%), dysesthesia (0.5%) and deep vein thrombosis (DVT) (0.1%). Endovenous laser ablation effectively improves clinical symptoms and quality of life in patients with GSV incompetence. It is a valid, minimally invasive procedure for treating GSV incompetence with minimal complications and a short recovery period.

Keywords

• 1470 nm laser treatment
• saphenous insufficiency
• before-after
• intervention
• quality of life

References

1. Azar, J., A. Rao, and A. Oropallo, Chronic venous insufficiency: a comprehensive review of management. J Wound Care, 2022. 31(6): p. 510-519.
2. Beebe-Dimmer, J.L., J.R. Pfeifer, J.S. Engle, and D. Schottenfeld, The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol, 2005. 15(3): p. 175-84.
3. Onida, S. and A.H. Davies, Predicted burden of venous disease. Phlebology, 2016. 31(1_suppl): p. 74-79.
4. Hamann, S.A.S., et al., Editor's Choice - Five Year Results of Great Saphenous Vein Treatment: A Meta-analysis. Eur J Vasc Endovasc Surg, 2017. 54(6): p. 760-770.
5. Rasmussen, L., et al., Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Journal of British Surgery, 2011. 98(8): p. 1079-1087.
6. Karathanos, C., et al., Prospective comparative study of different endovenous thermal ablation systems for treatment of great saphenous vein reflux. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2021. 9(3): p. 660-668.
7. Leopardi, M., et al., Endovenous laser ablation with 1,470-nm diode with tumescence anesthesia and saphenofemoral ligation: propensity score match comparison. Annals of vascular surgery, 2019. 58: p. 302-308.
8. Kuenstner, J. and K. Norris, Spectrophotometry of Human Hemoglobin in the near Infrared Region from 1000 to 2500 nm. Journal of Near Infrared Spectroscopy, 1994. 2: p. 59.

9. Pannier, F., E. Rabe, and U. Maurins, First results with a new 1470-nm diode laser for endovenous ablation of incompetent saphenous veins. Phlebology, 2009. 24(1): p. 26-30.
10. Elzefzaf, N., et al., Evaluation of Endovenous Laser Ablation in the Management of Varicose Veins. Cureus, 2023. 15(9): p. e45096.
11. Park, J.A., et al., The 1,470-nm bare-fiber diode laser ablation of the great saphenous vein and small saphenous vein at 1-year follow-up using 8–12 W and a mean linear endovenous energy density of 72 J/cm. Journal of Vascular and Interventional Radiology, 2014. 25(11): p. 1795-1800.
12. Malskat, W.S., et al., Commonly used endovenous laser ablation (EVLA) parameters do not influence efficacy: results of a systematic review and meta-analysis. European Journal of Vascular and Endovascular Surgery, 2019. 58(2): p. 230-242.
13. Ferreira, M.B., et al., Use of 1,470 nm laser for treatment of superficial venous insufficiency. Jornal Vascular Brasileiro, 2021. 20.
14. Venermo, M., et al., Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins. Journal of British Surgery, 2016. 103(11): p. 1438-1444.
15. Vourliotakis, G., G. Sahsamanis, P. Evagelidis, and C. Aivatidi, Endovascular laser treatment of incompetent saphenous veins using the 1470 nm diode laser and radial fiber. Annals of Medicine and Surgery, 2018. 25: p. 12-16.
16. Rajendran, S. and H.R. Nair, Endovenous laser ablation of incompetent great saphenous veins with 1470-nm laser using bare tip and radial fibers results in similar short-term outcomes. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2021. 9(5): p. 1209-1214.
17. Van Den Bos, R.R., M. Neumann, K.P. De Roos, and T. Nijsten, Endovenous laser ablation-induced complications: review of the literature and new cases. Dermatol Surg, 2009. 35(8): p. 1206-14.
18. Khilnani, N.M., et al., Multi-society consensus quality improvement guidelines for the treatment of lower-extremity superficial venous insufficiency with endovenous thermal ablation from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology and Canadian Interventional Radiology Association. J Vasc Interv Radiol, 2010. 21(1): p. 14-31.