Endovenous laser ablation of varicose veins with the 1470-nm diode laser

Background

Endovenous laser ablation (EVLA) is one of the most accepted treatment options for varicose veins. In previous studies conducted with a laser at 810 to 1320 nm, paresthesia, pain, and ecchymosis were common adverse effects. We hypothesized that a lower linear endovenous energy density (LEED), as used with 1470-nm diode laser fibers, would lead to a reduction in adverse events.

Methods

We conducted a prospective, nonrandomized observational cohort study of 312 consecutively treated lower limbs legs in 286 patients. Of these, a bare laser fiber was used to treat 168 legs in 150 patients (group 1), and a radial fiber was used in 144 legs in 136 patients (group 2). Laser treatment was performed in the great saphenous vein. Follow-up for all patients was 3 months. The primary end point was the occurrence of ecchymosis and bruising. This was correlated to the reduced LEED needed with the 1470-nm diode laser.

Results

Laser fiber (odds ratio [OR], 22.3; 95% confidence interval [CI], 20.2-24.5) and body mass index (OR, 0.35; 95% CI, 0.15-0.55) were identified as independent parameters for LEED. In group 2 compared with group 1, LEED in the great saphenous vein could be reduced from 79.4 ± 9.1 to 57.4 ± 10 J/cm (P < .0001). LEED was an independent parameter for skin bleeding (OR, 1.04; 95% CI, 1.017-1.058). Ecchymosis and bruising were significantly less frequent in group 2 than in group 1 (P < .0001). The need for analgesia was low, with 103.08 ± 15.34 mg diclofenac-sodium in group 1 vs 82.08 ± 18.86 mg in group 2 (P < .04). Occlusion with elimination of reflux was achieved in 100% of group 1 and group 2 (P < 1). No recanalization occurred at follow-up.

Conclusion

Endovenous laser treatment of varicose veins in the great saphenous vein with the 1470-nm diode laser is safe and highly effective. The lower energy level needed using the radial laser fiber significantly minimized adverse effects compared with the bare laser fiber.

Varicose veins are a common disease in Western countries, with a prevalence of up to 20% in men and >25% in women.1 In the last decade, the spectrum of treatment for varicose veins has been broadened. New, less invasive treatment options than surgery have been introduced, such as ultrasound-guided foam sclerotherapy, radiofrequency ablation, and endovenous laser ablation (EVLA). The first report on EVLA was published in 1999.2 Several studies have since been published reporting different regimens for the energy per surface area (J/cm), pulse duration, and wavelength of the laser. The published data on efficacy and safety of laser treatment arise from a laser with a wavelength between 810 and 1320 nm and show 90% to 100% occlusion.3, 4, 5, 6 and 7

A new-generation laser with a longer wavelength of 1470 nm was recently introduced. Some have hypothesized that efficacy would be higher due to higher specificity for the interstitial water in the vessel wall of this laser and lower absorption by hemoglobin7,8 and 9; however, data are scarce. We assessed the efficacy and safety of the new laser with 1470-nm wavelength in a prospective study in consecutive patients and compared efficacy and safety of the 1470-nm bare fiber vs the 1470-nm radial laser fiber. We also studied the lower linear endovenous energy density (LEED) used with the different 1470-nm laser fibers and its correlation to the observed postinterventional skin bleeding.

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