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Feasibility and safety of flush endovenous laser ablation of the great saphenous vein up to the saphenofemoral junction
摘要： Objective: The optimal ablation distance from the catheter tip to the common femoral vein during endovenous laser ablation (EVLA) of the great saphenous vein (GSV) is a matter of debate. In this study, we evaluated the feasibility and safety of ?ush ablation (fEVLA) of the GSV. Methods: This single-center, retrospective analysis of prospectively collected data included all consecutive fEVLA interventions of the GSV between September 2017 and October 2018. Interventions were performed with a 1470-nm radially emitting ?ber. Primary end points were technical feasibility of fEVLA and endovenous heat-induced thrombosis (EHIT) class 2 to class 4. Secondary end points were procedure-related complications; anatomic success at week 6; and ?ush occlusion at day 1, day 10, and week 6. Results: A total of 135 consecutive intended fEVLA procedures were performed in 113 patients (86 female, 27 male). The average body mass index was 24.9 6 4.3 kg/m2. The Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class for these patients was C2 in 78 (57.8%), C3 in 48 (35.6%), C4 in 8 (5.9%), and C5 in 1 (0.7%). The GSV diameter at the saphenofemoral junction was 9.4 6 2.7 mm with a maximum of 16 mm. In 126 cases (93.3%), concomitant treatment of tributaries with phlebectomy or foam sclerotherapy was performed. In 127 cases (94.1%), fEVLA was technically feasible; in 8 cases (5.9%), appropriate catheter tip placement was not possible. In these cases, “standard” GSV ablation 10 to 20 mm distal to the saphenofemoral junction was performed. In the remaining 127 cases, one (0.8%) EHIT class 2 and one (0.8%) EHIT class 3 developed at day 10. After a 2- to 3-week course of anticoagulation with rivaroxaban, these EHIT cases resolved without sequelae. Furthermore, one (0.8%) super?cial vein thrombosis and one (0.8%) calf vein thrombosis at the site of phlebectomy were observed. No local groin complication occurred. Flush occlusion was observed in 94.5%, 95.3%, and 88.2% of the cases at day 1, day 10, and week 6, respectively. Multivariate regression analysis revealed no signi?cant association between ?ush ablation at day 1 and age, body mass index, CEAP class, ?ber type, maximum vein diameter, or applied joules per centimeter. Conclusions: The results of this study suggest that fEVLA of the GSV using a radial emitting laser is feasible and seems to be safe.
关键词： Endovenous crossectomy,Endovenous laser ablation,Varicose veins,Great saphenous vein,Flush endovenous laser ablation
更新于2025-09-23 15:19:57
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Progress in Endovenous Pulsed Laser Ablation
摘要： Continuous-wave (CW) lasers have been commonly used for endovenous laser ablation (EVLA). However, as some undesired side effects such as postoperative pain and bruising occasionally happens, longer laser wavelength and specially-fabricated laser fibers have been developed. On the other hand, the pulsed-wave (PW) laser, which has a heat production control by thermal relaxation, is independently developed for EVLA. This article discusses the implication of PW laser in EVLA from a theoretical point of view and a newly-developed micropulsation (MP) is introduced as a new concept. Since the MP yields adequate blood and vein wall heat degeneration by microseconds laser emission, efficacy and safety are improved compared with CW laser or conventional PW laser. Initial clinical outcome is favorable and promising for painless EVLA using inexpensive bare fiber.
关键词： varicose vein,thermal relaxation time,micropulsation,endovenous laser ablation,clear tip mode
更新于2025-09-23 15:19:57
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Comparison of combined compression and surgery with high ligation-endovenous laser ablation-foam sclerotherapy with compression alone for active venous leg ulcers
摘要： We aimed to assess the ulcer healing time and recurrence rates after treatment with compression therapy (ct) with or without high ligation-endovenous laser ablation-foam sclerotherapy (HL-eVLA-fS) in people with active venous leg ulcers (VLUs). A retrospective cohort study was conducted with 350 patients with active VLUs treated by compression with or without HL-eVLA-fS in our hospital from 2013 to 2017. The primary outcome was the ulcer healing time; secondary outcomes were the 12-month recurrence rates, the relationship between recurrence and venous reflux, and the complications of the two treatments. In total, 193 patients (200 limbs) underwent compression plus HL-EVLA-FS, and 157 patients (177 limbs) underwent CT alone. The ulcer healing time was shorter in the compression plus HL-EVLA-FS group than in the CT alone group (Hazard Ratio [HR] for ulcer healing, 1.845 [95% CI, 1.474–2.309], P = 0.0001). The 12-month ulcer recurrence rates were significantly reduced in the compression plus HL-EVLA-FS group (HR for ulcer recurrence, 0.418 [95% CI, 0.258–0.677], P = 0.0001). Calf perforator vein reflux (CPVR) and isolated superficial venous reflux (ISVR) were risk factors for ulcer recurrence. the combined operation with ct resulted in faster healing of VLUs, a lower ulcer recurrence rate and lower VcSS values after intervention than ct alone.
关键词： venous leg ulcers,ulcer healing time,high ligation-endovenous laser ablation-foam sclerotherapy,compression therapy,recurrence rates
更新于2025-09-16 10:30:52
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Laser ablation versus mechanochemical ablation in the treatment of primary varicose veins: A randomized clinical trial
摘要： Objective: to prospectively compare the surgical outcome of using endovenous laser ablation (EVLA) and mechano-chemical ablation (MOCA) in management of patients with primary varicose veins (VV). Methods: The present study prospectively recruited 100 patients with primary VV. They were randomly and equally allocated to one of two treatment group: the EVLA group (n ? 50) or the MOCA group (n ? 50). Before intervention, all patients underwent to clinical and ultrasound assessment of the vascular system. The Venous Clinical Severity Score was used to assess clinical severity. In addition, patients completed the Chronic Venous Insuf?ciency Questionnaire. The primary study outcome was treatment success. After intervention, patients were followed up at 1 week, 1 months, 6 months, and 12 months. Results: Operative success was achieved in all patients. The MOCA group had a signi?cantly shorter operative time when compared with EVLA group. The Venous Clinical Severity Score signi?cantly improved in both groups over the follow-up period and showed signi?cantly lower levels in the MOCA group. Perceived pain was signi?cantly improved in both groups postoperatively with no signi?cant differences. The Chronic Venous Insuf?ciency Questionnaire was signi?cantly improved after 12 months of operation without signi?cant differences between groups. MOCA patients had signi?cantly lower rate of postoperative phlebitis and signi?cantly shorter time to return to work. Conclusions: MOCA for primary VV is a feasible, effective, and safe procedure with better clinical outcome and lower rate of postoperative phlebitis when compared with EVLA.
关键词： Varicose veins,Mechanochemical laser ablation,Endovenous laser ablation
更新于2025-09-12 10:27:22
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Endovenous Laser Ablation Combined with Stripping Technique for Large Saphenous Varicose Veins: The Selection of Operation Technique
摘要： Objective: Saphenous varicose veins can be accomplished by various operative techniques that result in stripping, ablation, or ligation of the venous reflux section. Great saphenous vein (GSV) stripping is one of the standard operations for varicose veins to eliminate reflux of the sapheno-femoral junction. The goal of any treatment regimen is to eliminate the junctional varicose reflux to control congestive dysfunction. Endovenous laser ablation (EVLA) is safe and effective with less postoperative pain, bleeding, and peripheral nerve damage than open surgery. In this study, a patient with severe progression of primary saphenous varicose veins is presented. We report the outcome of combined surgical strategy and perioperative treatment for extremely swollen varicose veins of the lower limbs to improve leg symptoms and congestion and/or promote skin ulcer healing. Materials and Methods: The subjects included 42 patients (51 limbs) who underwent EVLA with stripping. The patients comprised 24 males and 18 females, who presented a maximum GSV diameter >15 mm. The Clinical-Etiological-Anatomic-Pathophysiologic classification identified 9, 20, 9, 2, 6, and 5 limbs with C2, C3, C4a, C4b, C5, and C6, respectively, among the 42 patients. Results: EVLA was used to treat GSV with a mean length of 16.1±2.8 cm. The mean of the maximum GSV diameter was 16.8±3.2 mm (14.6–21.8 mm). The preoperative visual analog scale (VAS) score was 82.1±12.1. After operation, the VAS gradually deteriorated to 31.3±17.9 (p<0.0001), 2.8±3.6 (p<0.0001), and 1.2±1.8 (p<0.0001) in 7 days, 1 month, and 3 months, respectively. Conclusion: We obtained a satisfactory outcome from our combined strategy and perioperative treatment for extremely swollen saphenous varicose veins. This approach may show the possibility that lower saphenous varicose veins can induce cosmetic and minimally invasive ameliorated intervention to avoid late-phase incompetent perforating veins.
关键词： endovenous laser ablation,stripping,varicose vein
更新于2025-09-12 10:27:22