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Viarengo, Luiz Marcelo Aiello, Gabriel Viarengo, Aline Meira Martins, Marília Wechellian Mancini et Luciana Almeida Lopes. « Resultados de médio e longo prazo do tratamento endovenoso de varizes com laser de diodo em 1940 nm : análise crítica e considerações técnicas ». Jornal Vascular Brasileiro 16, no 1 (mars 2017) : 23–30. http://dx.doi.org/10.1590/1677-5449.010116.
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Resumo Contexto Desde a introdução do laser endovenoso para tratamento das varizes, há uma busca pelo comprimento de onda ideal, capaz de produzir o maior dano seletivo possível com maior segurança e menor incidência de efeitos adversos. Objetivos Avaliar os resultados de médio e longo prazo do laser de diodo de 1940 nm no tratamento de varizes, correlacionando os parâmetros utilizados com a durabilidade do desfecho anatômico. Métodos Revisão retrospectiva de pacientes diagnosticados com insuficiência venosa crônica em estágio clínico baseado em clínica, etiologia, anatomia e patofisiologia (CEAP) C2 a C6, submetidos ao tratamento termoablativo endovenoso de varizes tronculares, com laser com comprimento de onda em 1940 nm com fibra óptica de emissão radial, no período de abril de 2012 a julho de 2015. Uma revisão sistemática dos registros médicos eletrônicos foi realizada para obter dados demográficos e dados clínicos, incluindo dados de ultrassom dúplex, durante o período de seguimento pós-operatório. Resultados A média de idade dos pacientes foi de 53,3 anos; 37 eram mulheres (90,2%). O tempo médio de seguimento foi de 803 dias. O calibre médio das veias tratadas foi de 7,8 mm. A taxa de sucesso imediato foi de 100%, com densidade de energia endovenosa linear (linear endovenous energy density, LEED) média de 45,3 J/cm. A taxa de sucesso tardio foi de 95,1%, com duas recanalizações por volta de 12 meses pós-ablação. Não houve nenhuma recanalização nas veias tratadas com LEED superior a 30 J/cm. Conclusões O laser 1940 nm mostrou-se seguro e efetivo, em médio e longo prazo, para os parâmetros propostos, em segmentos venosos com até 10 mm de diâmetro.
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Medeiros, Charles Angotti Furtado de. « Comparação entre o laser endovenoso e a fleboextração total da veia safena interna : resultados em médio prazo ». Jornal Vascular Brasileiro 5, no 4 (décembre 2006) : 277–87. http://dx.doi.org/10.1590/s1677-54492006000400007.
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OBJETIVO: Comparar a fotocoagulação endovenosa com laser diodo e a fleboextração total da veia safena interna. MÉTODOS: Trata-se de um estudo prospectivo, controlado e cego de 20 pacientes com varizes sintomáticas e insuficiência bilateral da veia safena interna que foram operados entre março de 2002 e fevereiro de 2004. Para cada caso, foram realizadas aleatoriamente (sorteio) as duas técnicas, sendo uma em cada lado. A avaliação pós-operatória consistiu na aplicação de questionários, exame físico e fotografia digital em todos os pacientes desde o 7º dia de pós-operatório. Também foi realizado controle ultra-sonográfico no 30º dia de pós-operatório e pletismografia a ar no 60º dia após a cirurgia. Este projeto foi aprovado pela comissão de ética, e os pacientes foram incluídos ao assinarem o consentimento pós-informação. Os dados foram submetidos a análise estatística com os programas SPSS e SAS. RESULTADOS: A técnica que utilizou o laser endovenoso apresentou dor semelhante, mas menos edema e menos hematoma durante o pós-operatório. O índice de melhora estética e de satisfação com a cirurgia foi de 100% para as duas técnicas, mas a maioria dos pacientes respondeu que o membro operado com o laser foi o mais beneficiado. Houve melhora do tempo de enchimento venoso nos dois grupos, mas sem diferença significativa entre eles. Durante o seguimento (média de 26 meses), houve um caso de parestesia leve e transitória do lado convencional e somente uma recanalização do lado laser. CONCLUSÃO: A fotocoagulação endovenosa para o tratamento da veia safena interna em pacientes com varizes de membros inferiores é segura e apresenta resultados comparáveis aos da fleboextração convencional.
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Viarengo, Luiz Marcelo Aiello, Guilherme Vieira Meirelles et João Potério Filho. « Tratamento de varizes com laser endovenoso : estudo prospectivo com seguimento de 39 meses ». Jornal Vascular Brasileiro 5, no 3 (septembre 2006) : 184–93. http://dx.doi.org/10.1590/s1677-54492006000300006.
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OBJETIVO: Avaliar os resultados da terapêutica endovenosa com laser no tratamento de varizes primárias. PACIENTES E MÉTODO: No período compreendido entre julho de 2001 e setembro de 2004 (39 meses), 253 pacientes (417 membros) foram tratados ambulatorialmente com laser de diodo de 810 e 980-nm, com energia liberada endovenosamente através de fibra óptica introduzida por punção guiada por eco-Doppler. Foi utilizada anestesia por infiltração intumescente perivasal com solução de lidocaína a 0,2% (50-150 ml). A potência e duração do pulso foram determinadas pelo diâmetro da veia. Os controles foram realizados com eco-Doppler aos 7 dias, 1 mês, 3 meses, 6 meses, 1 ano e, a seguir, anualmente, para avaliar a eficácia do tratamento e os efeitos adversos. RESULTADOS: A oclusão primária da veia safena magna foi obtida em 405 dos 417 membros (97,1%) tratados. Houve reintervenção em 12 casos (2,9%), com sucesso. O tempo médio de observação foi de 18 meses, e, nesse período, a taxa de recidiva global de varizes foi de 7,4%, sendo 6,3% (26 membros) veias colaterais tributárias da crossa e 1,2% (cinco membros) com recanalização da safena magna. Todas as recorrências ocorreram entre o terceiro e o 12º mês. Os efeitos indesejáveis mais freqüentes foram: equimoses (60,6%); dor suportável durante o procedimento (16,1%); hematomas (5,5%); flebite em colaterais não-tratadas (3,4%); hiperpigmentação (2,9%); e parestesia transitória (3,4%). Nenhum caso de tromboflebite da safena magna foi observado. Não houve nenhum caso de trombose venosa profunda ou embolia pulmonar. CONCLUSÃO: O tratamento endovenoso de varizes com laser, conforme descrito, foi eficaz para ocluir a safena magna e seus principais ramos, com efeitos adversos autolimitados e com recorrência inferior a 8% no período de seguimento.
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Araujo, Walter Junior Boim de, Fabiano Luiz Erzinger, Filipe Carlos Caron, Carlos Seme Nejm Junior et Jorge Rufino Ribas Timi. « Influência da termoablação com baixa e alta densidade de energia na junção safeno-femoral, utilizando laser endovenoso 1470 nm ». Jornal Vascular Brasileiro 16, no 3 (21 août 2017) : 220–26. http://dx.doi.org/10.1590/1677-5449.010916.
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Resumo Contexto Faz-se importante o conhecimento técnico dos ajustes de potência e de densidade de energia linear endovenosa (linear endovenous energy density, LEED) adequados para atingir o objetivo final da termoablação endovenosa (endovenous laser ablation, EVLA). Objetivos Avaliar a influência de diferentes LEEDs em termos de patência e presença de refluxo, bem como determinar a evolução clínica. Métodos Foram incluídas 60 veias safenas magnas (VSM). Os pacientes foram randomizados em dois grupos: EVLA com baixa potência (7 W e LEED de 20-40 J/cm) e com alta potência (15 W e LEED de 80-100 J/cm). O acompanhamento com eco-Doppler e escore de severidade clínica venoso (VCSS) foi realizado nos intervalos de 3-5 dias, 30 dias, 180 dias e 1 ano após o procedimento. Resultados Dezoito pacientes (29 membros) tratados com 7W de potência e 13 pacientes (23 membros) com 15 W completaram o estudo. Não houve diferença significativa considerando idade, tempo de cirurgia e o uso de analgésicos, lateralidade, gênero e presença de comorbidades. O LEED médio foi de 33,54 J/cm no grupo de 7 W e de 88,66 J/cm no de 15 W. Ambos apresentaram melhora no VCSS, redução significativa dos diâmetros da JSF e ausência de diferença significativa quanto ao aumento do comprimento do coto da VSM e de refluxo após o tratamento. Conclusões A utilização de maior densidade de energia mostrou-se mais efetiva em relação à estabilização do comprimento do coto da VSM e do refluxo em 6 meses. Fazem-se necessários estudos com um período de acompanhamento maior para fundamentar essa hipótese.
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Araujo, Walter Junior Boim de, Adriano Carvalho Guimarães et Ricardo Herkenhoff Moreira. « Fístula arteriovenosa após termoablação com laser endovenoso 1470 nm : relato de caso ». Jornal Vascular Brasileiro 15, no 3 (19 septembre 2016) : 254–58. http://dx.doi.org/10.1590/1677-5449.003516.
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Resumo O tratamento tradicional da insuficiência da veia safena magna (VSM) inclui a ligadura alta na junção safeno-femoral combinada com a fleboextração. No entanto, a morbidade associada à insatisfação do paciente com esse tratamento tem conduzido ao desenvolvimento de técnicas alternativas, e a termoablação com laser endovenoso (EVLT) tornou-se uma alternativa minimamente invasiva à cirurgia. A formação de fístula arteriovenosa (FAV) durante o EVLT é extremamente rara. Neste estudo, relatamos um caso de identificação ecográfica de FAV entre um segmento da veia safena acessória lateral e a artéria femoral superficial. Optou-se inicialmente pela realização de duas tentativas de compressão com transdutor linear, sem sucesso, e alternativamente o procedimento cirúrgico foi realizado sem intercorrência e com resolução da FAV. Esse relato de caso evidencia a importância do seguimento de vigilância ecográfica após o EVLT tanto para o controle da efetividade do método como para o diagnóstico e tratamento precoce de suas complicações.
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Miranda, Samilly Silva, Laís Ramos Queiroz et Valéria Souza Freitas. « PREVENÇÃO E TRATAMENTO DAS MUCOSITES ORAIS : UMA REVISÃO SISTEMÁTICA ». Revista de Saúde Coletiva da UEFS 6, no 2 (6 janvier 2017) : 66. http://dx.doi.org/10.13102/rscdauefs.v6i2.1189.
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A proposta deste estudo foi realizar uma revisão sistemática da literatura, sobre mucosite oral (MO) em pacientes submetidos à radioterapia e quimioterapia para tratamento de tumores na região de cabeça e pescoço, de modo a levantar evidências científicas sobre prevenção e tratamento destas complicações. Os procedimentos metodológicos foram baseados nas recomendações da Cochrane Collaboration. Após a realização da busca nas bases de dados, obteve-se 3203 artigos, destes, 22 foram selecionados. Sete reportaram a terapia com Laser, três artigos avaliaram o uso do Mel, dois sobre o uso de Palifermin®, além de estudos sobre o Actovegin® endovenoso, enxaguatórios bucais a base de calêndula, fenilbutirato, clorexidina e cloreto de cetil-piridino. Outros abordaram o uso da radioterapia pela manhã, a crioterapia, o suco de aloe vera, o papel do Lactobacillus Brevis, do maleato de irsogladina e do fator de crescimento epidérmico. Os resultados obtidos nesta investigação apontam que a terapia com laser de baixa potência ainda é a mais indicada na prevenção e tratamento da mucosite oral. Entretanto, ainda é necessária a continuidade dos estudos que visam responder à temática, visto que, quanto maior for o esforço nessa área, maiores serão as chances de reduzir o número de indivíduos acometidos pela MO.
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Medeiros, Charles Angotti Furtado de. « Estudo comparativo entre o laser endovenoso e a fleboextração convencional da veia safena interna em pacientes com varizes primárias ». Jornal Vascular Brasileiro 5, no 1 (mars 2006) : 78. http://dx.doi.org/10.1590/s1677-54492006000100016.
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Allameh, Farzad, Atefeh Javadi, Sahar Dadkhahfar, Zahra Naeeji, Atefeh Moridi, Niki Tadayon et Sam Alahyari. « A Systematic Review of Elective Laser Therapy during Pregnancy ». Journal of Lasers in Medical Sciences 12, no 1 (19 septembre 2021) : e50-e50. http://dx.doi.org/10.34172/jlms.2021.50.
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Introduction: Currently, lasers are used to treat many diseases and their complications. However, the use of lasers in pregnant patients is still controversial. Methods: In this review, the application of lasers in the fields of urology, surgery, obstetrics, dermatology, and musculoskeletal disorders is evaluated. The following keywords were used to search through PubMed, Google Scholar, and Scopus: pregnancy, laser, urolithiasis, endovenous laser ablation (EVLA) or treatment, leg edema, varicose vein, venous insufficiencies, hair removal, pigmentation, telangiectasia, vascular lesions, Q switch laser, diode laser, holmium, holmium-YAG laser, erbium laser and Pulsed dye laser, low-level laser therapy, high-intensity laser therapy, pain, musculoskeletal disorders, twin to twin transfusion syndrome (TTTS), amnioreduction, and safety. Results: Totally, 147 articles were found, and their abstracts were evaluated; out of 53 articles extracted, 14 articles were about dermatology, 24 articles were about urology, 12 articles were about obstetrics and gynecology, 10 articles were about musculoskeletal disorders and three articles were related to surgery. Conclusion: Laser therapy can be used as a safe treatment for urolithiasis, skin diseases, TTTS and varicose veins of the lower extremities. However, the use of laser therapy for musculoskeletal disorders during pregnancy is not recommended due to lack of evidence, and also we cannot recommend endovenous ablation.
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Erzinger, Fabiano Luiz, Walter Junior Boim de Araujo, Carlos Seme Nejm Junior, Filipe Carlos Caron et Jorge Rufino Ribas Timi. « Estudo comparativo da termoablação da veia safena magna na coxa, com e sem tumescência ». Jornal Vascular Brasileiro 15, no 3 (20 octobre 2016) : 217–23. http://dx.doi.org/10.1590/1677-5449.004616.
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Resumo Contexto O tratamento com laser endovenoso das veias safenas oferece ao paciente um procedimento com baixos índices de complicações, proporcionando retorno precoce à atividade ocupacional. Objetivo Comparar a formação de hematoma, a presença de parestesia no trajeto da veia safena magna (VSM) e a sua taxa de obliteração em 30 dias após a termoablação ao nível da coxa, utilizando ou não a tumescência e dois tipos de fibras. Métodos Estudo prospectivo em que foram analisados três grupos de pacientes submetidos a termoablação da VSM em coxa, utilizando comprimento de onda 1470 nm. No grupo 1, utilizou-se fibra convencional e tumescência; no grupo 2, fibra convencional sem tumescência; e no grupo 3, fibra dupla radial sem tumescência. Foram comparados, no período de 30 dias, a taxa de obliteração ao eco-Doppler, a ocorrência de parestesias e hematomas. Resultados Ao se comparar 90 VSMs de coxa submetidas a termoablação, obteve-se taxas de obliterações similares entre os grupos, sem diferença estatística. Nos grupos sem tumescência, ocorreu maior número de parestesias no trajeto da VSM na coxa no sétimo dia do que no grupo com tumescência, mas somente com significância estatística na comparação com o grupo da fibra convencional. Ocorreram hematomas em todos os grupos, sendo mais frequentes no grupo 1 (73,33%). Conclusões A realização da tumescência mostrou-se útil na prevenção de lesões neurológicas menores, mas não influenciou a ocorrência de hematomas e a taxa de oclusão da VSM na coxa em até 30 dias de sua termoablação.
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Hennings, T., D. Hennings et C. Lindsay. « Thrombus formation using endovenous lasers : an in vitro experiment ». Phlebology : The Journal of Venous Disease 29, no 3 (6 mai 2013) : 171–78. http://dx.doi.org/10.1177/0268355512473921.
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Objectives: The purpose of these experiments was to simulate thrombus formation during endovenous laser closure by measuring coagulum formation of in vitro laser exposures in porcine blood and investigate the role of procedures and equipment in thrombus formation. Methods: Continuous wave 810, 940, 980, 1310 and 1470 nm lasers and microsecond pulsed wave 1064 nm Nd:YAG (neodymium-doped yttrium aluminium garnet), 1320 nm Nd:YAG and 2100 nm THC:YAG (thulium holmium chromium-doped yttrium aluminium garnet) lasers were tested with standard fibres with diameters of 365, 550 and 600 μm as well as two prototype modified tip fibres. Results: The results show that pulsed lasers with high-peak power densities form less coagulum. Fibre specifications were found not to influence coagulum formation, and prototype modified tip fibres designed to prevent contact between the fibre tip and the vein wall did not eliminate coagulum formation. Conclusion: Microsecond-pulsed wave lasers with high-peak power densities may be a better choice to minimize soft thrombus formation during endovenous laser ablation treatments.
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Cayne, N., G. Jacobowitz, P. Lamparello, T. Maldonado, C. Rockman, M. Adelman et L. S. Kabnick. « Endovenous procedures in varicose veins ». Phlebologie 37, no 05 (2008) : 229–36. http://dx.doi.org/10.1055/s-0037-1622235.
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SummaryOver the past ten years endoveous treatment options for varicose veins have evovled considerably, offering clinicians a multitude of options to meet the needs of their patients. The endothermal ablation procedures have moved to the forefront as the choice modality for treating truncal reflux. Both radiofrequency ablation and endovenous laser ablation are widely accepted and interchangeable, showing comparable efficacy and safety. Although numerous endovenous laser wavelengths exist, the data indicates that the differences do not affect the efficacy or postoperative recovery of the procedure. The endovenous laser innovation that has shown early evidence of improved patient outcome is the jacket-tip fiber. The versatility of sclerotherapy makes it a critical component in the endovenous treatment of varicosities. Although not approved by the Food and Drug Administration (USA), the use of a foamed sclerosing agent is the fastest growing segment of sclerotherapy and an important treatment modality in the future of varicose vein treatment. Cutaneous lasers and intense pulse light devices contribute a crucial element, enabling clinicians to treat minute veins that may be impossible to treat with other therapies.
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Flessenkämper, I., M. Hartmann, K. Hartmann, D. Stenger et S. Roll. « Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatment of great saphenous varicose veins : Results of a multicentre randomised controlled trial with up to 6 years follow-up ». Phlebology : The Journal of Venous Disease 31, no 1 (22 octobre 2014) : 23–33. http://dx.doi.org/10.1177/0268355514555547.
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Objectives High ligation and stripping was compared to endovenous laser ablation for the therapy of great saphenous vein varicosity. Long-term efficacy was assessed in terms of avoidance of inguinal reflux and mechanisms of recurrence were investigated. Design Multicentre, randomised, three-arm, parallel trial. Materials and methods A total of 449 patients were randomised into three different treatment groups: high ligation and stripping group ( n = 159), endovenous laser ablation group ( n = 142; 980 nm, 30 W continuous mode, bare fibre) or a combination of laser ablation with high ligation (endovenous laser ablation group/ high ligation group, n = 148). Patients were examined clinically and by duplex ultrasound once a year. The primary end point of this study is inguinal reflux at the saphenofemoral junction after 2 years. This paper presents secondary data on sonographically determined inguinal reflux and clinical recurrences in the treated area after up to 6 years of follow-up. Results Median time to follow-up was 4.0 years; the mean time follow-up 3.6 years. Follow-up rates were: 2 years 74%, 3 years 47%, 4 years 39%, 5 years 36% and 6 years 31%. Most reflux into the great saphenous vein appeared in the endovenous laser ablation group (after 6 years: high ligation/stripping versus endovenous laser ablation p = 0.0102; high ligation/endovenous laser ablation vs. endovenous laser ablation p < 0.0002). Furthermore, more refluxive side branches were also observed in the endovenous laser ablation group (after 6 years high ligation/stripping vs. endovenous laser ablation p = 0.0569; high ligation/endovenous laser ablation vs. endovenous laser ablation p = 0.0111). In terms of clinical recurrence during the 6 years post therapy, no significant differences between the three treatment groups were observed ( p values from log-rank test: high ligation/stripping vs. endovenous laser ablation p = 0.5479; high ligation/stripping vs. high ligation/endovenous laser ablation p = 0.2324; high ligation/endovenous laser ablation vs. endovenous laser ablation p = 0.0848). The postoperative decline and later development in Class C (clinical etiological anatomical pathological) went parallel in all groups. Conclusions Clinical recurrence appears with the same frequency in all three treatment groups, but the responsible pathological mechanisms seem to differ. Most reflux into the great saphenous vein and side branches appears after endovenous laser ablation, whereas more saphenofemoral junction-independent recurrences are seen after high ligation/stripping.
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Rass, K. « Current clinical evidence on endovenous laser ablation (EVLA) from randomised trials ». Phlebologie 45, no 04 (juillet 2016) : 201–6. http://dx.doi.org/10.12687/phleb2317-4-2016.
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SummaryBackground Endovenous laser ablation (EVLA) is globally counted among the most frequently administered methods to treat saphenous vein incompetence. Technical development proceeded in three particular steps: EVLA #1 – Diode lasers linearly emitting wavelengths from 810 to 980 nm through optical bare fibres; EVLA #2 – Diode or Nd:YAG lasers emitting wavelengths from 1064 to 1500 nm; EVLA #3 – Modified optical fibres warranting an optimised emission geometry by centralisation of the fibre tip (Tulip-fibre, Jacket-tip) or radial emission of the laser beam. Due to the number of different EVLA techniques their value compared with standard surgery (high ligation and stripping, HLS) and other endovascular approaches has to be questioned.Methods Selective literature analysis based on a systematic PubMed search focussed on randomised controlled trials (RCT) comparing EVLA with HLS and other thermal or nonthermal ablation techniques – radiofrequency ablation (RFA), ultrasound guided foam sclerotherapy (UGFS), endothermal steam ablation (EStA).Results The search terms “endovenous”, “laser”, “varicose vein” resulted in 509 publications, hereof 57 RCTs, hereof 24 randomised studies comparing EVLA with other treatment approaches: 15 studies comprise comparisons with standard surgery and further 9 studies with other endovenous techniques. 6 RCTs contain long-term followup data on EVLA #1 vs. HLS suggesting superiority of HLS in terms of same site clinical and duplex detected recurrence from the groin. 15 RCTs are reporting short-term results clearly demonstrating inferiority of EVLA #1 against EVLA #2, EVLA #3, and RFA with respect to postoperative complaints and patients’ quality of life.Conclusions The first generation endovenous laser systems are disadvantageous or even harmful as compared with more advanced EVLA techniques and RFA in terms of patients’ complaints and side effects. Furthermore, evidence is rising that EVLA #1 is inferior to standard surgery regarding long-term treatment efficacy. Therefore, the application of EVLA #1 in the treatment of saphenous vein incompetence cannot be recommended any longer. In view of the more recently published RCTs reporting long-term superiority of standard surgery, HLS should still be implemented as control group in studies investigating endovenous treatment approaches.
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Kansaku, Rei, Naoki Sakakibara, Atsushi Amano, Hisako Endo, Takashi Shimabukuro et Michiaki Sueishi. « Histological difference between pulsed wave laser and continuous wave laser in endovenous laser ablation ». Phlebology : The Journal of Venous Disease 30, no 6 (30 mai 2014) : 429–34. http://dx.doi.org/10.1177/0268355514538248.
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Background Endovenous laser ablation to saphenous veins has been popular as a minimally invasive treatment for chronic venous insufficiency. However, adverse effects after endovenous laser ablation using continuous wave laser still remain. Pulsed wave with enough short pulse duration and sufficiently long thermal relaxation time may avoid the excess energy delivery, which leads to the perforation of the vein wall. Method (1) Free radiation: Laser is radiated in blood for 10 s. (2) Endovenous laser ablation: Veins were filled with blood and placed in saline. Endovenous laser ablations were performed. Results (1) There were clots on the fiber tips with continuous wave laser while no clots with pulsed wave laser. (2) In 980-nm continuous wave, four of 15 specimens had ulcers and 11 of 15 had perforation. In 1470-nm continuous wave with 120 J/cm of linear endovenous energy density, two of three presented ulcers and one of three showed perforation. In 1470-nm continuous wave with 60 J/cm of linear endovenous energy density, two of four had ulcers and two of four had perforation. In 1320-nm pulsed wave, there were neither ulcers nor perforation in the specimens. Conclusions While endovenous laser ablation using continuous wave results in perforation in many cases, pulsed wave does not lead to perforation.
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Yusupov, Vladimir, et Vladimir Chudnovskii. « The origin of loud claps during endovenous laser treatments ». Journal of the Acoustical Society of America 153, no 3 (mars 2023) : 1525–33. http://dx.doi.org/10.1121/10.0017436.
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Optoacoustic and ultrasound methods have shown that the loud “claps” perceived by patients and medical staff during endovenous laser ablation (EVLA) are caused by volumetric blood boiling when large vapor–gas bubbles appear and collapse under the action of laser radiation, which is well absorbed in water. Acoustic effects when using lasers in the near infrared range (1.94, 1.47, and 0.97 μm) were studied in an experiment with non-deaerated water, as well as in EVLA. The nature of these acoustic signals was investigated using high-speed video recording. It turned out that the amplitude of the emerging acoustic pulses in the case of surface boiling, which prevails when using lasers with a wavelength of 0.97 μm, is two orders of magnitude smaller than in the case of volumetric boiling (1.94 and 1.47 μm). The reasons for the decrease in sound effects in this case are associated with numerous microbubbles at the tip of the laser fiber. The results obtained may be useful for further understanding of the mechanisms of EVLA.
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Teter, Katherine A., Lowell S. Kabnick et Mikel Sadek. « Endovenous laser ablation : A comprehensive review ». Phlebology : The Journal of Venous Disease 35, no 9 (6 juillet 2020) : 656–62. http://dx.doi.org/10.1177/0268355520937619.
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Objective To provide an evidence-based overview of endovenous laser ablation and describe its role as an effective and durable technique for the management of superficial venous insufficiency. Methods The published literature on the treatment of varicose veins using endovenous laser ablation was reviewed. The literature search focused on the history of endovenous laser ablation, its safety and durability, known complications, and differences in outcomes based on the iterations of fiber type and laser wavelength. Results Treatment safety and efficacy of endovenous laser ablation appear to be based on the amount of energy administered over a defined distance, or the linear endovenous energy density. The ideal linear endovenous energy density varies with the laser wavelength and fiber-type. Post-operative pain and bruising may be reduced by the use of higher wavelength fibers or the use of radial or jacket-tip fibers as compared to bare-tip fibers. The incidence of endothermal heat-induced thrombosis remains low and has declined with increasing experience. Reports have demonstrated a greater than 90% technical success rate with saphenous endovenous laser ablation, long-term durability of ablation, and commensurate improvement in quality of life. Conclusions Endovenous laser ablation is a safe and durable treatment option for the management of incompetent superficial and perforator veins of the lower extremities. As an endothermal technology, it remains a key component of the standard of care for the treatment of chronic venous insufficiency.
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NAVARRO, LUIS, ROBERT J. MIN et CARLOS BONÉ. « Endovenous Laser ». Dermatologic Surgery 27, no 2 (février 2001) : 117–22. http://dx.doi.org/10.1097/00042728-200102000-00004.
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NAVARRO, LUIS, ROBERT J. MIN et CARLOS BONÉ. « Endovenous Laser ». Dermatologic Surgery 27, no 2 (février 2001) : 117–22. http://dx.doi.org/10.1046/j.1524-4725.2001.00134.x.
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Lun, Yu, Shikai Shen, Xiaoyu Wu, Han Jiang, Shijie Xin et Jian Zhang. « Laser fiber migration into the pelvic cavity : A rare complication of endovenous laser ablation ». Phlebology : The Journal of Venous Disease 30, no 9 (25 juin 2014) : 641–43. http://dx.doi.org/10.1177/0268355514541982.
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Endovenous laser ablation is an established alternative to surgery with stripping for the treatment of varicose veins. Ecchymoses and pain are frequently reported side effects of endovenous laser ablation. Device-related complications are rare but serious. We describe here an exceptional complication, necessitating an additional surgical procedure to remove a segment of laser fiber that had migrated into the pelvic cavity. Fortunately, severe damage had not occurred. This case highlights the importance of checking the completeness of the guidewire, catheter, and laser fiber after endovenous laser ablation.
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Sufian, S., A. Arnez, N. Labropoulos et S. Lakhanpal. « Endovenous heat-induced thrombosis after ablation with 1470 nm laser : Incidence, progression, and risk factors ». Phlebology : The Journal of Venous Disease 30, no 5 (7 mars 2014) : 325–30. http://dx.doi.org/10.1177/0268355514526588.
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Objectives To evaluate the incidence of heat-induced thrombosis, its progression and risk factors that may contribute to its formation after endovenous laser ablation. Methods 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. Results 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. Conclusion 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.
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Vuylsteke, M., J. Van Dorpe, J. Roelens, Th De Bo et S. Mordon. « Endovenous laser treatment : a morphological study in an animal model ». Phlebology : The Journal of Venous Disease 24, no 4 (20 juillet 2009) : 166–75. http://dx.doi.org/10.1258/phleb.2009.008070.
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Objectives The destruction induced during endovenous laser treatment (ELT) of the saphenous vein and the perivenous tissue in an animal model (goats) was analysed. Differences in vein wall destruction produced by two laser types, the 980 and 1500 nm diode lasers, were evaluated histologically. Methods In 14 goats, 28 lateral saphenous veins were treated with ELT. In 14 veins we used the 980 nm diode laser and in the remnant a 1500 nm laser. Postoperatively the veins were removed at different stages and sent for histological examination. Results Immediately removed veins after ELT show an uneven destruction of the vein wall. Veins harvested one week postoperatively show inflammatory tissue at their periphery. Two and three weeks postoperatively, organization is very extensive. In some cases, recanalization begins in a semi-lunar manner at the contralateral side of the laser hit. Veins treated with a 980 nm laser show deeper ulceration with more perivenous tissue destruction compared with veins treated with a 1500 nm diode laser. Conclusions The ELT of veins produces an unevenly distributed damage. The cell necrosis is far more extensive than expected. Uneven vein wall destruction can lead to recanalization. Using a 1500 nm laser correlates with less penetrating ulcerations and more circumferential damage.
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Elmore, F. A., et D. Lackey. « Effectiveness of endovenous laser treatment in eliminating superficial venous reflux ». Phlebology : The Journal of Venous Disease 23, no 1 (février 2008) : 21–31. http://dx.doi.org/10.1258/phleb.2007.007019.
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Objective To describe a protocol for endovenous laser treatment that is highly effective, has no significant complications, and is well accepted by patients. This is the first published report that designates complete absence of the treated vein as the definition of a successful endovenous laser treatment. Methods A retrospective review of 516 endovenous laser treatments performed by a single physician in private medical practice over a 69-month period. Follow-up ranged from 3 to 65 months. All treatments were performed utilizing 810 nm laser energy (Diomed, Inc.). Periodic duplex ultrasound examinations were performed until the treated vein was absent. Surveys were done to assess post treatment pain and to evaluate the effect of treatment on quality of life. Results The described protocol for endovenous laser treatment has successfully eliminated 98.1% of 516 treated veins with a single laser treatment. Additionally, in the last 386 treated veins when increased energy levels were utilized, the success rate was 99.7%. There were no significant complications. Patient satisfaction with the procedure is extremely high. Conclusions Endovenous laser treatment is a highly effective procedure for eliminating superficial venous reflux in varicose veins selected for treatment when sufficient 810 nm (Diomed, Inc.) laser energy is utilized.
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Balint, Renata, Akos Farics, Krisztina Parti, Laszlo Vizsy, Jozsef Batorfi, Gabor Menyhei et Istvan B. Balint. « Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein ? Review ». Vascular 24, no 6 (9 juillet 2016) : 649–57. http://dx.doi.org/10.1177/1708538116648035.
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Objective The aim of this review article was to evaluate the long-term technical success rates of the known endovenous ablation procedures in the treatment of the incompetence of the great saphenous vein. Methods A literature search was conducted in the PubMed-database until the 5 January 2016. All publications with four to five years follow-up were eligible. Meta-analysis was performed by the IVhet-model. Results Eight hundred and sixty-two unique publications were found; 17 of them were appropriate for meta-analysis. Overall, 1420 limbs were included in the trial, 939 for endovenous laser ablation, 353 for radiofrequency ablation and 128 for ultrasound guided foam sclerotherapy. Overall, technical success rates were 84.8% for endovenous laser ablation, 88.7% for radiofrequency ablation and 32.8% for ultrasound guided foam sclerotherapy. There were no significant differences between endovenous laser ablation, radiofrequency ablation and ultrasound guided foam sclerotherapy regarding the great saphenous vein reopening ( p = 0.66; OR: 0.22; 95% of CI: 0.08–0.62 for radiofrequency ablation vs. endovenous laser ablation; p = 0.96; OR: 0.11; 95% of CI: 0.06–0.20 for endovenous laser ablation vs. ultrasound guided foam sclerotherapy; p = 0.93; OR: 3.20; 95% of CI: 0.54–18.90 for ultrasound guided foam sclerotherapy vs. radiofrequency ablation). Conclusion Both endovenous laser ablation and radiofrequency ablation are efficient in great saphenous vein occlusion on the long term. Lacking long-conducted large trials, the efficacy and reliability of ultrasound guided foam sclerotherapy to treat great saphenous vein-reflux is not affirmed.
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Spinedi, Luca, Daniel Staub et Heiko Uthoff. « Successful lysis in a stroke following endovenous laser ablation and extensive miniphlebectomy of varicose veins ». Phlebology : The Journal of Venous Disease 31, no 4 (6 octobre 2015) : 296–98. http://dx.doi.org/10.1177/0268355515610235.
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Stroke is a very rare but potential fatal complication of endovenous thermal treatment in patients with a right-to-left shunt. To our best knowledge, there are only two reports in the literature of stroke after endovenous thermal ablation of varicose veins, one after endovenous laser ablation and one after radiofrequency ablation and phlebectomy, both treated conservatively. This report describes a successful lysis in a patient with an ischemic stroke associated with bilateral endovenous heat-induced thrombosis class I after endovenous laser ablation of both great saphenous vein and extensive miniphlebectomy in a patient with an unknown patent foramen ovale.
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Lynch, Noel P., M. Clarke et Greg J. Fulton. « Surgical management of great saphenous vein varicose veins : A meta-analysis ». Vascular 23, no 3 (15 juillet 2014) : 285–96. http://dx.doi.org/10.1177/1708538114542633.
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Purpose The purpose of this systematic review and meta-analysis is to synthesise the available evidence of randomised controlled trials comparing endovenous laser therapy to traditional open surgery, high ligation and stripping, for the treatment of great saphenous vein varicose veins in terms of clinical effectiveness, patient satisfaction and peri-operative complications. Methods MEDLINE, CINAHL, EMBASE and the Cochrane library were searched to identify eligible studies. All randomised controlled trials comparing endovenous laser therapy to high ligation and stripping that used ultrasound examination as an outcome measure and had follow up of one year or more were included. The Cochrane Collaboration’s tool for assessing risk of bias was also used to assess the methodological quality of the included studies. Pooled risk ratios with 95% confidence intervals were used as the measure of effect for each dichotomous outcome. Findings Nine eligible publications relating to six randomised controlled trials were identified. The total enrolment of the studies was 1289 limbs. The clinical efficacy of endovenous laser therapy is comparable to that of surgery in the relatively short follow up period described in the studies. Meta-analysis revealed a trend towards a higher risk of ultrasound recurrence after endovenous laser therapy at 12 months. Quality of life questionnaires reveal similar outcomes for endovenous laser therapy and surgery. There is low quality evidence to suggest surgery is associated with more pain, sensory complications and infection. Conclusion Endovenous laser therapy is a safe alternative to traditional open surgery. There is some weak evidence to suggest that endovenous laser therapy has a higher risk of ultrasound-detected recurrence at 12 months following treatment compared to open surgery. However, it may be associated with less sensory complications, pigmentation and infection.
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Guzelmansur, Ismail, Levent Oguzkurt, Nihal Koca, Cagatay Andic, Murat Gedikoglu et Ugur Ozkan. « Endovenous laser ablation and sclerotherapy for incompetent vein of Giacomini ». Phlebology : The Journal of Venous Disease 29, no 8 (11 juillet 2013) : 511–16. http://dx.doi.org/10.1177/0268355513496552.
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Purpose To retrospectively evaluate the feasibility and effectiveness of endovenous laser ablation or ultrasound-guided foam sclerotherapy for Giacomini vein insufficiency. This is the largest cohort of patients treated for Giacomini vein insufficiency with endovenous laser ablation or ultrasound-guided foam sclerotherapy. Material and methods Over a three-year period, 23 females and nine males (age range, 19–67 years) treated for Giacomini vein insufficiency with or without saphenous vein insufficiency were retrospectively reviewed. Diagnosis of venous insufficiency was made by color Doppler ultrasonography. Symptomatic insufficiency of the Giacomini vein or the saphenous veins was treated with endovenous laser ablation. Ultrasound-guided foam sclerotherapy was used for tortuous incompetent Giacomini veins. The venous disease was categorized according to the clinical, etiological, anatomical, and pathological classification, and clinical severity was graded with the venous clinical severity score. Follow-up included clinical examination and color Doppler ultrasonography. Results Thirty-nine limbs in 32 patients were treated (25 endovenous laser ablation and seven ultrasound-guided foam sclerotherapy). All procedures were technically successful. One patient in the ultrasound-guided foam sclerotherapy group had a recurrence with successful repeated treatment. Recurrence was not seen in the endovenous laser ablation group. No complications were observed. All patients had resolution and improvement in 100% of their symptoms at 12 months of follow-up. Conclusion Giacomini vein insufficiency is mostly seen with insufficiency of the great saphenous vein and can be effectively treated with endovenous laser ablation or ultrasound-guided foam sclerotherapy.
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Dabbs, Emma B., Laurensius E. Mainsiouw, Judith M. Holdstock, Barrie A. Price et Mark S. Whiteley. « A description of the ‘smile sign’ and multi-pass technique for endovenous laser ablation of large diameter great saphenous veins ». Phlebology : The Journal of Venous Disease 33, no 8 (28 septembre 2017) : 534–39. http://dx.doi.org/10.1177/0268355517734480.
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Aims To report on great saphenous vein diameter distribution of patients undergoing endovenous laser ablation for lower limb varicose veins and the ablation technique for large diameter veins. Methods We collected retrospective data of 1929 (943 left leg and 986 right leg) clinically incompetent great saphenous vein diameters treated with endovenous laser ablation over five years and six months. The technical success of procedure, complications and occlusion rate at short-term follow-up are reported. Upon compression, larger diameter veins may constrict asymmetrically rather than concentrically around the laser fibre (the ‘smile sign’), requiring multiple passes of the laser into each dilated segment to achieve complete ablation. Results Of 1929 great saphenous veins, 334 (17.31%) had a diameter equal to or over 15 mm, which has been recommended as the upper limit for endovenous laser ablation by some clinicians. All were successfully treated and occluded upon short-term follow-up. Conclusion We suggest that incompetent great saphenous veins that need treatment can always be treated with endovenous laser ablation, and open surgery should never be recommended on vein diameter alone.
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Altin, Firat H., Selim Aydin, Kamuran Erkoc, Tevfik Gunes, Bortecin Eygi et Baris H. Kutas. « Endovenous laser ablation for saphenous vein insufficiency : Short- and mid-term results of 230 procedures ». Vascular 23, no 1 (19 février 2014) : 3–8. http://dx.doi.org/10.1177/1708538114522997.
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Objective The present study aimed to evaluate the efficacy of endovenous laser ablation with a 1470-nm laser and to analyze the short- to mid-term results of endovenous laser ablation procedures to treat great saphenous vein insufficiency. Method In this retrospective study, 200 patients (230 limbs) with symptomatic varicose veins secondary to great saphenous vein insufficiency treated with 1470-nm endovenous laser ablation were studied. Patients were evaluated clinically on the first day, first week, first month, and sixth month after the operation. Treated limbs were evaluated as separate treatment events. Results The short-term occlusion rate was 99% and mid-term occlusion rate was 100%. Induration or swelling was the most common minor complication (13%). No major complication such as deep venous thrombosis and pulmonary embolus occurred. Preoperatively documented mean venous clinical severity score significantly reduced from 4.9 ± 2.3 to 2.5 ± 1.1 ( p < 0.05). Conclusion Endovenous laser ablation procedure of great saphenous vein with a 1470-nm diode laser is a minimally invasive, safe, and efficient treatment option in all-suitable patients with high short- and mid-term success rate.
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Vuylsteke, M., D. Van den Bussche, E. A. Audenaert et P. Lissens. « Endovenous laser obliteration for the treatment of primary varicose veins ». Phlebology : The Journal of Venous Disease 21, no 2 (1 juin 2006) : 80–87. http://dx.doi.org/10.1258/026835506777304683.
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Objective: The aim of this study was to compare the minimally invasive endovenous laser technique for treatment of primary varicose veins with the conventional stripping operation in terms of short-term recovery and cost for economically active patients. Methods: One hundred and sixty four patients with varicose veins caused by great saphenous vein insufficiency were assigned to the endovenous laser obliteration procedure ( n = 80, 118 legs) or stripping operation ( n = 84, 124 legs). Postoperative morbidity, the need for analgesics and the duration of sick leave were recorded. The comparison of costs included both direct medical costs and costs resulting from lost productivity of the patients. Results: Overall there were less postoperative complications in the laser group. Sick leave was significantly shorter in the endovenous obliteration group ( P<0.001). Although the variable costs of the conventional stripping operation were lower than those of the endovenous laser procedure, the total costs at public expense were higher because of the difference in lost productivity of the patients. Conclusions: Endovenous laser obliteration may offer advantages over the stripping operation in terms of reduced postoperative pain, shorter sick leave and faster return to usual occupational activities, and it appears to be cost-saving for society.
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Pongratz, T., K. Siegrist, C. Burgmeier, H. D. Barth, C. G. Schmedt et R. Sroka. « Endovenous Laser Application ». Phlebologie 42, no 03 (mars 2013) : 121–29. http://dx.doi.org/10.12687/phleb2134-3-2013.
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SummaryIntroduction: Endoluminal vein treatment is a promising minimal invasive treatment option for peoples suffering from varicose veins. The basic mechanism underlying this procedure is to selectively induce heat in the vessel wall with the result of denaturation of proteins and shrinkage of collagen fibers due to energy application. So far energy could be applied either as RF-current, laser light or water steam. The different approaches to deliver such forms of energies are described.Methods: Investigations on heat dependent vein tissue effects were performed. The degree of shrinkage and wall thickening due to heat induction was calculated. Tensile test on vein tissue were performed. Investigation using the radial emitting laser fibre in the ox-foot-model under reproducible condition were done and wavelengths dependent tissue reaction were explored.Results: The experiments clearly demonstrate the degree of the shrinkage of length and diameter, the thickening of the vein wall, as well as the decrease of the elasticity of the tissue. The optical irradiation pattern of the radial emitting laser fiber serves for safe and reproducible energy application directly to the vein wall. Using a laser wavelength with high absorption by the tissue water needs reduced irradiation and irradiance compared to wavelengths with less water absorption. Conclusion: An experimental approach to improve laser application for endovenous varicose treatment is described. Laser parameters and treatment parameters were found which are now under clinical testing. The demonstrated tissue effects may help to find further arguments for clinical findings and sensations described by the patients during follow-up.
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Chi, Y.-W., et T. C. Woods. « Clinical risk factors to predict deep venous thrombosis post-endovenous laser ablation of saphenous veins ». Phlebology : The Journal of Venous Disease 29, no 3 (6 mai 2013) : 150–53. http://dx.doi.org/10.1177/0268355512474254.
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Objective: Endovenous laser ablation of saphenous veins is an alternative in treating symptomatic varicose veins. Deep venous thrombosis (DVT) has been reported in up to 7.7% of patients undergoing such procedure. We sought to establish clinical risk factors that predict DVT post-endovenous laser ablation. Method: Patients who underwent endovenous laser ablation were prospectively followed. Clinical data and post-interventional duplex ultrasound were analysed. A P value <0.05 was accepted as representing a significant difference. Results: From 2007 to 2008, 360 consecutive patients were followed. Nineteen DVTs were found on follow-up ultrasound. Eighteen cases involved either the saphenofemoral or saphenopopliteal junctions; only one case involved the deep venous system. Age >66 ( P = 0.007), female gender ( P = 0.048) and prior history of superficial thrombophlebitis (SVT) ( P = 0.002) were associated with increased risk of DVT postprocedure. Conclusion: Age >66, female gender and history of SVT were significant predictors of DVT post-endovenous laser ablation of saphenous veins.
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FORRESTAL, MARK D., HELANE S. FRONEK, MARK N. ISAACS, ROBERT J. MIN, KENNETH L. TODD et STEVEN E. ZIMMET. « Endovenous Laser Treatment ». Dermatologic Surgery 29, no 3 (mars 2003) : 312–13. http://dx.doi.org/10.1097/00042728-200303000-00025.
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WEISS, ROBERT. « Endovenous Laser Treatment ». Dermatologic Surgery 29, no 3 (mars 2003) : 313–14. http://dx.doi.org/10.1097/00042728-200303000-00026.
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Hemmerich, M., T. Pongratz, K. Siegrist, J. Brons, S. Linden, R. Meier, C. G. Schmedt et R. Sroka. « Endovenous Laser Application ». Phlebologie 42, no 03 (mars 2013) : 131–38. http://dx.doi.org/10.12687/phleb2135-3-2013.
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SummaryIntroduction: Endovenous laser ablation is becoming a common procedure in clinical routine. Although technical improvements and certain laser parameters are available there is demand to improve the situation by developing feedback-systems, thus getting online information for the clinical outcome and preventing for under- and over-treatment.Methods: By means of Monte Carlo simulation the potential of detecting signals due to heat induced shrinkage of the vessel was investigated. Remission spectra of native and coagulated vein tissue were compared to identify potential parameters for signalling the physiological change of the tissue due to the heating process. A miniaturized temperature sensor was developed for intraluminal measurements during laser energy application.Results: Monte Carlo simulation shows that the detection of remitted light from the vessels wall is possible for small vessel calibres of less than 6 mm in diameter. Remission spectra of native compared to coagulated vein tissue differ. While native tissue relates more to the content of deoxy-hemoglobin, the spectra of coagulated tissue relates more to the oxy-hemoglobin state. Based on the principle of temperature dependent fluorescence emission a miniaturized sensor was developed which can be used in the light field of radial emitting fibres.Conclusion: Several optical changes for online-monitoring of signals during endovenous laser ablation showed potential to serve as feedback mechanism. Up to now, only the measurement of the endoluminal temperature could be realized. Further investigations are needed to find suitable technical realization to prevent for under- or overheating during endovenous laser ablation.
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Forrestal, Mark D., Helane S. Fronek, Mark N. Isaacs et Robert J. Min. « Endovenous Laser Treatment ». Dermatologic Surgery 29, no 3 (mars 2003) : 312–14. http://dx.doi.org/10.1046/j.1524-4725.2003.29073.x.
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Khilnani, Neil M. « Endovenous Laser Ablation ». Journal of Vascular and Interventional Radiology 16, no 2 (février 2005) : P148—P149. http://dx.doi.org/10.1016/s1051-0443(05)70134-2.
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Sydnor, Malcolm, John Mavropoulos, Natalia Slobodnik, Luke Wolfe, Brian Strife et Daniel Komorowski. « A randomized prospective long-term (>1 year) clinical trial comparing the efficacy and safety of radiofrequency ablation to 980 nm laser ablation of the great saphenous vein ». Phlebology : The Journal of Venous Disease 32, no 6 (15 juillet 2016) : 415–24. http://dx.doi.org/10.1177/0268355516658592.
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Purpose To compare the short- and long-term (>1 year) efficacy and safety of radiofrequency ablation (ClosureFAST™) versus endovenous laser ablation (980 nm diode laser) for the treatment of superficial venous insufficiency of the great saphenous vein. Materials and methods Two hundred patients with superficial venous insufficiency of the great saphenous vein were randomized to receive either radiofrequency ablation or endovenous laser ablation (and simultaneous adjunctive therapies for surface varicosities when appropriate). Post-treatment sonographic and clinical assessment was conducted at one week, six weeks, and six months for closure, complications, and patient satisfaction. Clinical assessment of each patient was conducted at one year and then at yearly intervals for patient satisfaction. Results Post-procedure pain ( p < 0.0001) and objective post-procedure bruising ( p = 0.0114) were significantly lower in the radiofrequency ablation group. Improvements in venous clinical severity score were noted through six months in both groups (endovenous laser ablation 6.6 to 1; radiofrequency ablation 6.2 to 1) with no significant difference in venous clinical severity score ( p = 0.4066) or measured adverse effects; 89 endovenous laser ablation and 87 radiofrequency patients were interviewed at least 12 months out with a mean long-term follow-up of 44 and 42 months ( p = 0.1096), respectively. There were four treatment failures in each group, and every case was correctable with further treatment. Overall, there were no significant differences with regard to patient satisfaction between radiofrequency ablation and endovenous laser ablation ( p = 0.3009). There were no cases of deep venous thrombosis in either group at any time during this study. Conclusions Radiofrequency ablation and endovenous laser ablation are highly effective and safe from both anatomic and clinical standpoints over a multi-year period and neither modality achieved superiority over the other.
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Hashimoto, Osamu, Takuya Miyazaki, Joji Hosokawa, Yumi Shimura, Hiroshi Okuyama et Masahiro Endo. « A case of high-output heart failure caused by a femoral arteriovenous fistula after endovenous laser ablation treatment of the saphenous vein ». Phlebology : The Journal of Venous Disease 30, no 4 (19 février 2014) : 290–92. http://dx.doi.org/10.1177/0268355514525149.
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Endovenous laser ablation treatment has become the less invasive therapeutic choice for the treatment of superficial venous insufficiency and varicose veins. A 64-year-old woman presented at our hospital with varicose veins and prior endovenous laser ablation treatment. The patient had high-output heart failure caused by a right femoral arteriovenous fistula. She was treated medically and underwent an open repair of the right superficial femoral artery and the right femoral vein with complete resolution of the arteriovenous fistula and heart failure. Here, we have reviewed the literature and discussed possible causes of the complication of arteriovenous fistula after endovenous laser ablation treatment.
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Darwood, R. J., et M. J. Gough. « Endovenous laser treatment for uncomplicated varicose veins ». Phlebology : The Journal of Venous Disease 24, no 1_suppl (avril 2009) : 50–61. http://dx.doi.org/10.1258/phleb.2009.09s006.
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Objective Endovenous laser ablation (EVLA) of incompetent truncal veins has been proposed as a minimally invasive alternative to conventional surgery for varicose veins. Various strategies have been proposed for successful treatment and this study reviews the evidence for these. Method A Medline and ‘controlled trials online database’ search was performed to identify original articles and randomized controlled trials (RCTs) reporting outcomes for EVLA. Information on patient selection, equipment, technique and outcomes were recorded. Results Ninety-eight original studies, including five RCTs, were identified. RCT data indicate short-term outcomes (abolition of reflux, improvement in quality of life [QOL], patient satisfaction) were equivalent to those for surgery. Long-term follow-up is not available. A further RCT showed superior outcomes for ablation commencing at the lowest point of superficial venous reflux rather than at an arbitrary point (fewer residual varicosities, greater improvement in QOL). Non-randomized series suggest that laser energy of >60 J/cm results in reliable truncal vein occlusion and that longer wavelength lasers may be associated with less post-treatment discomfort. Conclusion In the short-term EVLA is a safe and effective treatment for patients with varicose veins. Long-term follow-up is still required.
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Filippov, V. A., M. I. Shakirov et A. P. Kirshin. « Endovasal laser vein obliteration in patients with varicose disease of the lower extremities in the ambulatory practice ». Kazan medical journal 93, no 2 (15 avril 2012) : 270–73. http://dx.doi.org/10.17816/kmj2305.
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Aim. To evaluate the results of treatment of patients with varicose disease of the lower extremities using endovenous laser obliteration. Methods. Endovenous laser obliteration of the saphenous and perforating veins was used in the treatment of 72 patients with varicose disease of the lower extremities by applying a laser with a wavelength of 1.56 µm. The intervention technique included puncturing and catheterizing of the great saphenous vein or small saphenous vein under ultrasound angioscanning control followed by an introduction of the laser fiber-optic light guide and advancing it to the level of the saphenofemoral or saphenopopliteal junction. After paravasal introduction of the anesthetic solution the laser obliteration was performed under ultrasound control. Results. Postoperatively noted was the low intensity of pain, low severity of ecchymosis and no tenderness along the obliterated veins. No complications were recorded. 40 patients were examined in follow-up during the period from 2 to 4 months after the endovenous laser obliteration. The degree of obliteration of 39 great saphenous veins, 2 small saphenous veins and 8 perforating veins was evaluated. In all cases complete obliteration of veins subjected to laser exposure was noted, no abnormal refluxes or areas of preserved blood flow were revealed. Conclusion. The endovenous laser obliteration is a mini-invasive effective method of providing a complete occlusion of the blood vessel, which eliminates the vertical and horizontal pathological reflux in varicose disease of the lower extremities; this technique can be used in an outpatient setting.
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Çalık, Eyüp Serhat, Ümit Arslan et Bilgehan Erkut. « Ablation therapy with cyanoacrylate glue and laser for refluxing great saphenous veins – a prospective randomised study ». Vasa 48, no 5 (1 août 2019) : 405–12. http://dx.doi.org/10.1024/0301-1526/a000792.
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Summary: Background: Endovenous cyanoacrylate ablation is a new technique for the treatment of clinically symptomatic venous insufficiency. The results of a prospective comparative study of cyanoacrylate glue versus endovenous laser ablation for the management of incompetent great saphenous veins are presented. Patients and methods: A total of 400 subjects were treated with cyanoacrylate ablation or endovenous laser ablation between April 2014 and April 2016. The preprocedural, procedural, postprocedural, and follow-up data were recorded and compared. Results: There were 208 procedures in cyanoacrylate ablation group (CAA) and 204 in endovenous laser ablation group (EVLA). Operative time was 13 ± 3.4 minutes in the CAA and 31.7 ± 8.8 minutes in the EVLA (< 0.001). All procedures in both groups were successful, and the target vein segments were fully occluded at the end of the procedure. Periprocedural pain was less in the CAA (< 0.001). Enduration, ecchymosis, and paresthesia rates were significantly higher in the EVLA (< 0.001). The mean length of follow-up was 14 months (range 10–16). The 3, 6 and 12 months closure rates were 97.4%, 95.6%, and 94.1% for EVLA and 98.6%, 97.1% and 96.6% for CAA respectively. In both groups, the Venous Clinical Severity Score and Chronic Venous Insufficiency Quality of Life Questionnaire with declined significantly with no difference between groups. Conclusions: Management of incompetent great saphenous veins both endovenous cyanoacrylate ablation and laser ablation results in high occlusion rates. Endovenous cyanoacrylate ablation technique is fast and simple with low periprocedural pain that does not require tumescent anesthesia and compression stockings.
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Abbasaliev, B. B. « IMPROVING THE EFFICIENCY OF TREATMENT OF TROPHIC ULCERS IN THE LOWER EXTREMITIES RESULTED FROM CHRONIC VENOUS INSUFFICIENCY ». Актуальні проблеми сучасної медицини : Вісник Української медичної стоматологічної академії 22, no 2 (27 septembre 2022) : 3–7. http://dx.doi.org/10.31718/2077-1096.22.2.3.
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The prevalence of varicose veins of the lower extremities and trophic ulcers, and as a consequence, deterioration of the quality of life, high rate of disability pose this problem as one of the social and healthcare challenges. The aim of the study is to evaluate the effectiveness of the low-intensity laser radiation in the integrated treatment of trophic ulcers of the lower extremities. Clinical and histomorphological studies were performed on 75 patients, 21 men and 54 women, aged from 15 to 75 years, who took the course of treatment for small and medium stage II ulcers on the lower extremities at the Educational and Surgical Clinic of the Azerbaijan Medical University and the Central Hospital of the Gazakh district. Criteria for inclusion in the study: both sexes, the presence of ulcerative necrotic lesions of the lower extremities. Exclusion criteria: heart failure, systemic diseases, cancerous diseases, hormone therapy, pregnancy. To conduct a comparative analysis, patients were randomly divided into three groups (25 individuals in each group): the main group, the comparison group and the control group. Venocoryl ointment, low-intensity laser radiation and endovenous laser ablation were used in the treatment of trophic ulcers of the lower extremities of small and medium sizes in the main group. The control group received regional treatment including standard retro-specific methods and endovenous laser ablation. The comparison group received endovenous laser ablation and Venocoryl ointment. When using Venocoryl ointment, low-intensity laser radiation and endovenous laser ablation in the treatment of trophic ulcers with leg varicose veins, a more pronounced decrease in pain sensations, faster relief of the inflammatory process and activation of reparative processes were observed on the 7th and 14th days after the beginning of the therapy compared to the control group and the comparison group. The use of Venocoryl ointment, low-intensity laser radiation and endovenous laser ablation reduces pain in the main group after 7 and 14 days compared with the control group.
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Cowpland, Christine A., Amy L. Cleese et Mark S. Whiteley. « Factors affecting optimal linear endovenous energy density for endovenous laser ablation in incompetent lower limb truncal veins – A review of the clinical evidence ». Phlebology : The Journal of Venous Disease 32, no 5 (12 mai 2016) : 299–306. http://dx.doi.org/10.1177/0268355516648067.
Texte intégralRésumé :
Objectives The objective is to identify the factors that affect the optimal linear endovenous energy density (LEED) to ablate incompetent truncal veins. Methods We performed a literature review of clinical studies, which reported truncal vein ablation rates and LEED. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow diagram documents the search strategy. We analysed 13 clinical papers which fulfilled the criteria to be able to compare results of great saphenous vein occlusion as defined by venous duplex ultrasound, with the LEED used in the treatment. Results Evidence suggests that the optimal LEED for endovenous laser ablation of the great saphenous vein is >80 J/cm and <100 J/cm in terms of optimal closure rates with minimal side-effects and complications. Longer wavelengths targeting water might have a lower optimal LEED. A LEED <60 J/cm has reduced efficacy regardless of wavelength. The optimal LEED may vary with vein diameter and may be reduced by using specially shaped fibre tips. Laser delivery technique and type as well as the duration time of energy delivery appear to play a role in determining LEED. Conclusion The optimal LEED to ablate an incompetent great saphenous vein appears to be >80 J/cm and <95 J/cm based on current evidence for shorter wavelength lasers. There is evidence that longer wavelength lasers may be effective at LEEDs of <85 J/cm.
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Ostler, Alexandra E., Judy M. Holdstock, Charmaine C. Harrison et Mark S. Whiteley. « Arterial false aneurysm in the groin following endovenous laser ablation ». Phlebology : The Journal of Venous Disease 30, no 3 (19 novembre 2013) : 220–22. http://dx.doi.org/10.1177/0268355513512826.
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Endovenous laser ablation is a minimally invasive catheter-based procedure for the treatment of varicose veins. The procedure involves injecting tumescent anaesthesia around the catheterised truncal vein, before thermal ablation by the laser. We report a case of a false aneurysm arising from a branch of the inferior epigastric artery, following endovenous laser ablation. The false aneurysm was thought to be caused by injury to the artery by the needle used to inject the tumescent anaesthesia. Although a rare complication, newer tumescentless techniques such as mechanicochemical ablation and cyanoacrylate glue would prevent such a complication.
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Eswaran, Kala, Ashish Dhadas et Sachin Patil. « Hyperbaric Intrathecal Ropivacaine in Patients Undergoing Endovenous Laser Ablation (EVLA) – A Case Series ». Journal of Anaesthesia and Critical Care Reports 8, no 2 (2022) : 3–5. http://dx.doi.org/10.13107/jaccr.2022.v08i02.198.
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Spinal anaesthesia using 0.75% ropivacaine heavy/hyperbaric can be used safely and effectively for endovenous laser ablation procedures (EVLA) on bilateral limb varicose veins without the increased duration of hospital stay in elderly patients with comorbidities. Hyperbaric 0.75% ropivacaine was found to give the adequate duration of spinal block along with hemodynamic stability and excellent post-operative recovery for EVLA procedures. Keywords: Endovenous Laser Ablation (EVLA), Spinal anaesthesia, 0.75% hyperbaric ropivacaine
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WEISS, ROBERT. « Commentary on Endovenous Laser ». Dermatologic Surgery 27, no 3 (mars 2001) : 326–27. http://dx.doi.org/10.1097/00042728-200103000-00027.
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Weiss, Robert. « Commentary on Endovenous Laser ». Dermatologic Surgery 27, no 3 (mars 2001) : 325–26. http://dx.doi.org/10.1046/j.1524-4725.2001.08011-3.x.
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Min, Robert J. « Endovenous Laser Ablation : Outcomes ». Journal of Vascular and Interventional Radiology 16, no 2 (février 2005) : P243—P244. http://dx.doi.org/10.1016/s1051-0443(05)70205-0.
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Weiss, Robert. « Commentary on Endovenous Laser ». Dermatologic Surgery 27, no 3 (mars 2001) : 325–26. http://dx.doi.org/10.1111/j.1524-4725.2001.8011-3.x.
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Gaspar, Ricardo José, André Nóbrega Castro, Manuel de Jesus Simões et Hélio Plapler. « Real time echo-guided endolaser for thermal ablation without perivenous tumescence ». Jornal Vascular Brasileiro 14, no 4 (décembre 2015) : 290–96. http://dx.doi.org/10.1590/1677-5449.07214.
Texte intégralRésumé :
Abstract Background There is no consensus in the medical literature on the ideal procedure for endovenous laser application. Objective To assess the safety and efficacy of real time echo-guided endovenous laser for thermal ablation of great saphenous vein (GSV) incompetence, without perivenous tumescence. Methods Thirty-four limbs of patients with CEAP clinical scores of 2 to 6 and bilateral incompetence of the saphenofemoral junction (SFJ) and GSV, confirmed by Echo-Doppler, underwent endovenous laser therapy and were followed for 1 year. Laser ablation was performed using a 600 µ bare optical fiber introduced endovenously close to the malleolus along the full extent of the GSV in an anterograde direction, using a standardized echo-Doppler-guided AND? 15 watt continuous mode 980 nm diode laser with real-time monitoring of thermal ablation of the whole target vein. Adverse effects and complications were recorded. Results Hyperesthesia, cellulitis, and fibrous cord, all transitory, developed in 2.9% of the 34 limbs treated; 8.8% developed hypoesthesia in the perimalleolar region, which was transitory and had no clinical consequences; there were no cases of deep venous thrombosis. Immediate occlusion was achieved in 100% of the 34 saphenous veins that underwent photocoagulation, although one exhibited recanalization without reflux at 1-month follow-up. After 6 months and 1 year, occlusion was 100% according to echo-Doppler findings. Conclusions Real-time echo-guided 980 nm endovenous laser ablation without perivenous tumescence provided controlled thermal ablation with safe, effective, immediate and medium-term GSV occlusion and can therefore be recommended as a method for the treatment of chronic venous disease.