Phlebologie 2017; 46(03): 131-135
DOI: 10.12687/phleb2357-3-2017
Review article
Schattauer GmbH

A review of endothermal laser ablative treatment of incompetent saphenous veins

Endothermale ablative Behandlung von Stammveneninsuffizienzen mittels Laser im Überblick
L. Schuler
1   Vein Centre Freiburg, Freiburg, Germany
,
K. Hartmann
1   Vein Centre Freiburg, Freiburg, Germany
› Author Affiliations
Further Information

Publication History

Received: 29 January 2017

Accepted: 00 February 2017

Publication Date:
04 January 2018 (online)

Summary

Endovenous treatment of incompetent great and small saphenous veins has become firmly established as an alternative to cross-ectomy and stripping operations. Among other thermal and non-thermal procedures, endovenous laser ablation (EVLA) is one of the most frequently used methods. Development of the procedure has continued since its introduction in 1998: the low wavelengths used at first (810 nm) resulted in a high rate of complications (ecchymosis, pain), and over the years systems using longer wavelengths have been developed with increasingly fewer side effects. The effectiveness of the wavelength most frequently used today (1470 nm) has been reported in numerous studies. The most frequent side effects include endovenous heat-induced thrombosis (EHIT), nerve damage and ecchymosis; major complications like lung embolism are reported very rarely.

Zusammenfassung

Die endovenöse Behandlung von Stammveneninsuffizienzen der Vena saphena magna und Vena saphena parva hat sich mittlerweile neben der Krossektomie und Strippingope-ration in den Therapieoptionen fest etabliert. Neben anderen thermischen und nichtthermischen Verfahren ist die endovenöse Laser-ablation (EVLA) eines der am häufigsten angewendeten Methoden. Seit 1998 entwickelt sich das Verfahren zunehmend weiter, die an-fangs angewendeten niedrigeren Wellenlängen, angefangen bei 810 nm, zeigten hohe Komplikationsraten (Ekchymosen, Schmerzen), im weiteren Verlauf wurden Systeme mit höheren Wellenlängen entwickelt, die zunehmend weniger Nebenwirkungen haben. Die Effektivität des aktuell am häufigsten angewendeten 1470 nm-Lasers ist in zahlrei-chen Studien belegt worden. Die häufigsten Nebenwirkungen umfassen das Auftreten einer Hitzeinduzieren Endovenösen Thromboembolie (EHIT), Nervenläsionen und Ekchymosen, Majorkomplikationen wie eine Lungenembolie treten sehr selten auf.

 
  • References

  • 1 Rabe E, Pannier F. Epidemiology of chronic venous disorders. In: Gloviciki P. (ed). Handbook of venous disorders. Hodder Arnold; 2009: 105-110.
  • 2 NICE Guideline CG 168. nice.org.uk/guidance/cg168 2013
  • 3 Kluess HG. et al. Leitlinie zur Diagnostik und Therapie der Krampfadererkrankung. Deutsche Gesellschaft für Phlebologie. 2009
  • 4 Kluess HG, Noppenney T, Gerlach H. et al. Leitlinie zur Diagnostik und Therapie des Krampfaderleidens. Phlebologie 2004; 33: 211-221.
  • 5 Hartmann K. Varicosis: Crossectomy and stripping versus endovenous techniques. Phlebologie 2016; 45: 129-180.
  • 6 Boné C. Tratamiento endoluminal de las varices con laser de Diodo. Estudio preliminary. Rev Patol Vasc 1999; 5: 35-46.
  • 7 Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc Interv Radiol 2003; 14 (Suppl. 08) 991-996.
  • 8 Proebstle TM, Gül D, Kargl A, Knop J. Endovenous laser treatment of the lesser saphenous vein with a 940-nm diode laser: early results. Dermatol Surg 2003; 29 (Suppl. 04) 357-361.
  • 9 Pannier F, Rabe E. Mid-term results following endovenous laser ablation (EVLA) of saphenous veins with a 980 nm diode laser. Int Angiol 2008; 27: 475-81.
  • 10 Pröbstle TM. 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: 596-600.
  • 11 Weiss RA. Comparison of endovenous radiofrequency versus 810 nm diode laser occlusion of large veins in an animal model. Dermatol Surg 2002; 28: 56-61.
  • 12 Agus GB, Mancini S, Magi G. The first 1000 cases of Italian Endovenous-laser Working Group (IEWG). Rationale, and long-term outcomes for the 1999–2003 period. Int Angiol 2006; 25 (Suppl. 02) 209-215.
  • 13 Goldman MP, Mauricio M, Rao J. Intravascular 1320-nm laser closure of the great saphenous vein: a 6– to 12-month follow-up study. Dermatol Surg 2004; 30 (Suppl. 11) 1380-1385.
  • 14 Pannier F, Rabe E, Maurins U. First results with a new 1470-nm diode laser for endovenous ablation of incompetent saphenous veins. Phlebology 2009; 24 (Suppl. 01) 26-30.
  • 15 Hartmann K. (Hrsg). Endovenöse Verfahren, Minimalinvasive Therapie der Varikosis. Stuttgart: Schattauer Verlag; 2015
  • 16 Mendes-Pinto D, Bastianetto P, Cavalcanti Braga Lyra L. et al. Endovenous laser ablation of the great saphenous vein comparing 1920 nm and 1470 nm diode laser. Int Angiol 2016; 35 (Suppl. 06) 599-604.
  • 17 Van den Bos R, Arends L, Kockaert M. et al. Endovenous therapy of lower extremity varicosities: A meta-analysis. J Vasc Surg 2009; 49: 230-239.
  • 18 Van der Velden SK, Pichot O, van den Bos RR. et al. Management strategies for patients with varicose veins (C2–C6): Results of a worldwide survey. Eur J Vasc Surg 2015; 49: 213-220.
  • 19 Pannier F, Rabe E, Rits J. et al. Endovenous laser ablation of great saphenous veins using a 1470 nm diode laser and the radial fibre – follow-up after six months. Phlebology 2011; 26 (Suppl. 01) 35-39.
  • 20 von Hodenberg E, Zerweck C, Knittel E. et al. Endovenous laser ablation of varicose veins with the 1470 nm diode laser using a radial fiber – 1-year follow-up. Phlebology 2015; 30 (Suppl. 02) 86-90.
  • 21 Maurins U. et al. Does laser power influence the results of endovenous laser ablation (EVLA) of incompetent saphenous veins with the 1 470-nm diode laser?. Int Angiol 2009; 28 (Suppl. 01) 32-37.
  • 22 Sporbert F. et al. Endoluminale Therapie der Vena saphena magna (VSM) bei Varikose/CVI Laser und Radiowelle im Fünfjahresvergleich. Phlebologie 2016; 45: 357-362.
  • 23 Flessenkämper I. et al. 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 2016; 31: 23-33.
  • 24 Rass K. Current clinical evidence of endovenous laser ablation (EVLA) from randomised trials. Phlebologie 2016; 45: 201-206.
  • 25 Sufian S, Arnez A, Labropoulos N, Lakhanpal S. Endovenous heat-induced thrombosis after ablation with 1470 nm laser: Incidence, progression, and risk factors. Phlebology 2015; 30 (Suppl. 05) 325-330.
  • 26 Shutze WP, Kane K, Fisher T. et al. The effect of wavelength on endothermal heat-induced thrombosis incidence after endovenous laser ablation. J Vasc Surg Venous Lymphat Disord 2016; 4: 36-43.
  • 27 Boersma D, Kornmann VN, van Eekeren RR. et al. Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis. J Endovasc Ther 2016; 23 (Suppl. 01) 199-211.
  • 28 Kabnick LS, Ombrellino M, Agis H. et al. Endovenous heat induced thrombus (EHIT) at the superficial-deep venous junction: a new post-treatment clinical entity, classification and potential treatment strategies. 18th Annual Meeting Am Venous Forum Miami: 2006
  • 29 Carroll C, Hummel S, Leaviss J. et al. Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation. Health Technol Assess 2013; 17: i-xvi 1–141.
  • 30 Ostler AE. et al. Primary avalvular varicose anomalies are a naturally occurring phenomenon that might be misdiagnosed as neovascular tissue in recurrent varicose veins. J Vasc Surg Venous Lymphat Disord 2014; 2 (Suppl. 04) 390-396.