EVLA treatment picture

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Ultrasound  image showing  the catheter and  the  laser fber inserted in the Saphenous vein




Duplex ultrasound  is performed  in  the upright posi-tion  to map  incompetent  sources of venous  refux and  then  to mark  the  skin  overlying the  incompetent  portion  of  the  great saphenous vein starting at the saphenofemoral junction




Duplex  control  is  used  to  guide  injection  of  7-  to 8-mL  aliquots of  the  following  solution: 10 mL  lidocaine 1% with epinephrine and 10 mL lidocaine 1% without epinephrine and additional 60 mL physiologic serum



To reduce the amount of blood inside the vein, patients are placed in a 15–20° head-down position (Trendelenburg position)



During  laser  irradiation,  the withdrawal of  the  laser fber is controlled to apply a constant linear endovenous energy density (in this case, a metric ruler)



At  the end of  the surgical procedure, venous com-pression  was  applied  for  24  h  by  irremovable  compression bandage

Radial fiber

Length: 3m 

Sterile packaging (ETO) 

NA 0.37 600μm

SMA 905 connector

Application: EVLA

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EVLA Mechanism of Action

EVLA  works  by  means  of  thermal  destruction  of venous tissues. Laser energy is delivered to the desired incompetent  segment  inside  the

vein  through  a  bare laser fber that has been passed through a sheath to thedesired location.

Several wavelengths have been proposed: 810, 940, 980, 1,064, and 1,320 nm, with 810, 940,  and  980  being  the most commonly  used. More recently,  use  of  a  1,470-  to  1,500-nm  diode  laser  has been  proposed. Wavelengths  of  1,470–1,500  nm  are preferentially absorbed by water.

When using laser light, heat is generated within the zone  of  optical  penetration  by  direct  absorption  of laser  energy.  Absorption  is  the

primary  event  that allows a  laser or other  light source  to cause a poten-tially  therapeutic  (or  damaging)  effect  on  a  tissue. Without absorption,  there  is no energy  transfer  to  the tissue  and  the  tissue  is  left  unaffected  by  the  light. Scattering  of  light  occurs  in  all  

biological  tissues: blood, vessel walls, and perivenous tissue. Due to fuc-tuations  in  the  refractive  index  of  these  media,  the propagation of light into the tissue is modifed and the scattering  affects  “where”  the  absorption will  occur, usually reducing the penetration of light into the tissue. 

Heating decreases with tissue depth as absorption and scattering  attenuate  the  incident  beam. Based  on  the absorption and effective scattering coeffcients of  the biological  tissue,  the  optical  extinction  (µeff)  can  be determined.

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EVLA Mechanism of Action

EVLA  works  by  means  of  thermal  destruction  of venous tissues. Laser energy is delivered to the desired incompetent  segment  inside  the vein  through  a  bare laser fber that has been passed through a sheath to the desired location.

Several wavelengths have been proposed: 810, 940, 0, 1,064, and 1,320 nm, with 810, 0,  and  980  being  the most  commonly  used. More cently,  use  of  a  1,470-  to  1,500-nm  diode  laser  has en  proposed. Wavelengths  of  1,470–1,500  nm  are eferentially absorbed by water.

When using laser light, heat is generated within the zone  of  optical  penetration  by  direct  absorption  of laser  energy.  Absorption  is  the primary  event  that allows a  laser or other  light source  to cause a poten-tially  therapeutic  (or  damaging)  effect  on  a  tissue. Without absorption,  there  is no energy  transfer  to  the tissue  and  the  tissue  is  left  unaffected  by  the  light. Scattering  of  light  occurs  in all biological  tissues: blood, vessel walls, and perivenous tissue. Due to fuc-tuations  in  the  refractive  index  of  these  media,  the propagation of light into the tissue is modifed and the scattering  affects  “where”  the  absorption will  occur, usually reducing the penetration of light into the tissue. 

Heating decreases with tissue depth as absorption and scattering  attenuate  the  incident  beam. Based  on  the absorption and effective scattering coeffcients of  the biological  tissue,  the  optical  extinction  (µeff)  can  be determined.

Absorption,  reduced  scattering  and  extinction  coeffcients  of  blood,  vessel wall,  and  perivenous  tissue  relative  to wavelength

This table clearly shows that the optical extinction is much higher at 1,470–1,500 nm (5–9 times higher) compared to 810, 940, 980, and 1,320 nm. Interestingly, for these wavelengths, the optical extinction is similar for blood and vessel wall

Varicose Veins: Endovenous Laser Treatment

Core Messages

Endovenous laser ablation (EVLA) has been developed as an alternative to surgery of the great saphenous vein and short saphenous vein in an attempt to reduce morbidity and improve recovery time.

EVLA can be performed in an outpatient special procedure room in a hospital.

EVLA works by means of thermal destruction of venous tissues. Several wavelengths can be used: 810, 940, 980, 1,064, 1,320, 1,470, and 1,500 nm.

Heating decreases with tissue depth as absorption and scattering attenuate the incident beam. Consequently,  the  laser  beam  must  heat  the 

vein wall and not the blood

Before  EVLA  is  performed,  the  vein  lumen must be emptied of its blood by using leg elevation  (Trendelenburg  positioning),  manual

compression, and infltration with perisaphenous subcutaneous tumescent saline solution.

The  appropriate  linear  endovenous  energy density (LEED) must be selected as a function of the diameter of treated segment. Veins larger 

than 9–12 mm in diameter are diffcult to treat, even when using higher energy.

In  a  general  manner,  side  effects  are  energy dependent. LEED more  than  100  J/cm  is  very often associated to superfcial burns and palpable indurations.

                                               

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