Endovenous Laser Ablation of Incompetent Perforating Veins with 1470 nm, 400 μm Radial Fiber

Background Endovenous Laser Ablation (EVLA) is one of the most accepted treatment options for varicose veins. The aim of this study was to investigate the efficacy and safety of the new radial fiber slim (ELVeS-radial-slim kit™) for the 1470 nm diode laser in perforator veins with a 1 month follow-up. Methods Our prospective observational cohort study comprised 69 perforating veins in 55 patients. Ninety percent of all patients were in the CEAP-stage C3-C6. The radial fiber slim was used to occlude the perforating vein and the great or small saphenous vein in the same procedure. The primary efficacy endpoint of the study was ultrasonographically proven elimination of venous reflux in the perforating vein after at least one month. Secondary efficacy and further safety end points after one month were as follows: (1) sonographic exclusion of recanalization of the treated vein segments, (2) deep vein thrombosis (DVT), clinical pulmonary embolism (PE), or superficial vein thrombosis (SVT) as defined by objective testing, (3) death from any cause, (4) persistent clinical complaints such as pain and paresthesia. Results Follow-up could be completed in all patients. In all treated perforating varicose veins, occlusion with elimination of reflux could be demonstrated immediately after the procedure. After one month 95.6% of the treated veins were still occluded (67/69). During follow-up, we did not diagnose any DVT, PE or SVT in the area related to the treated perforating vein. No patient died. One patient reported paresthesia distally of the puncture site. Conclusion Endovenous laser treatment of varicose perforating veins with 1470 nm diode laser using the radial fiber slim is effective and safe with low recanalization rates during 1-month follow-up.

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Endothermal ablation for the treatment of clinically significant incompetent lower limb perforating veins: factors influencing the early outcomes

Phlebology The Journal of Venous Disease ◽

10.1177/0268355520955085 ◽

2020 ◽

pp. 026835552095508

Author(s):

Kenneth R Woodburn

Keyword(s):

Radiofrequency Ablation ◽

Laser Ablation ◽

Lower Limb ◽

Closure Rate ◽

Short Treatment ◽

Endovenous Laser Ablation ◽

Perforating Veins ◽

Factors Influencing ◽

Early Closure ◽

Clinically Significant

Background To review the clinical experience and early outcomes of endothermal perforator ablation. Method Retrospective review of an endovenous practice from 2007-2019. Clinically significant incompetent perforators were treated by Endovenous Laser Ablation (EVLA), or segmental radiofrequency ablation (RFA). Result Complete data were available for 110 of the 116 symptomatic incompetent perforating veins treated. Radiofrequency ablation of 20 perforators produced a 55% perforator closure rate, while 90 EVLA perforator ablations resulted in a closure rate of 80%. Closure rates with EVLA varied by location and perforator length. Closure rates for truncal ablation were 95.5% for RFA and 97.2% for EVLA. Conclusion Early closure rates following endothermal ablation of incompetent lower limb perforating veins are lower than those obtained for truncal ablation. EVLA perforator closure appears to be more effective than segmental RFA in most situations but short treatment lengths and location at the ankle are associated with the poorest outcomes.

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Endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2014.04.012 ◽

2014 ◽

Vol 2 (4) ◽

pp. 403-410 ◽

Cited By ~ 7

Author(s):

Giorgio Spreafico ◽

Andrea Piccioli ◽

Enrico Bernardi ◽

Enzo Giraldi ◽

Patrizia Pavei ◽

...

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Endovenous Laser Ablation ◽

Radial Fiber

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Combined treatment with endovenous laser ablation and compression therapy of incompetent perforating veins for treatment of recalcitrant venous ulcers

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515594075 ◽

2015 ◽

Vol 32 (5) ◽

pp. 307-315 ◽

Cited By ~ 6

Author(s):

Mustafa Seren ◽

Mert Dumantepe ◽

Osman Fazliogullari ◽

Suha Kucukaksu

Keyword(s):

Laser Ablation ◽

Demographic Data ◽

Combined Treatment ◽

Average Energy ◽

Compression Therapy ◽

Ulcer Recurrence ◽

Recurrence Rates ◽

Endovenous Laser Ablation ◽

Perforating Veins ◽

Venous Ulcers

Objective Patients with healed venous ulcers often experience recurrence of ulceration, despite the use of long-term compression therapy. This study examines the effect of closing incompetent perforating veins (IPVs) on ulcer recurrence rates in patients with progressive lipodermatosclerosis and impending ulceration. Methods Patients with nonhealing venous ulcers of >2 months’ duration underwent duplex ultrasound to assess their lower extremity venous system for incompetence of superficial, perforating, and deep veins. Endovenous laser ablation (EVLA) of perforating veins was performed on patients with CEAP 6 disease with increasing hyperpigmentation, lipodermatosclerosis, and/or progressive malleolar pain. A minimum of 2 months of compressive therapy was attempted before endovenous ablation of IPVs. Demographic data, risk factors, CEAP classification, procedural details, and postoperative status were all recorded. Results Forty ulcers with 46 associated IPVs were treated with EVLA in 36 patients with CEAP 6 recalcitrant venous ulcers. Treated incompetent perforator veins were located in the medial ankle (85.7%), calf (10.7%), and lateral ankle (3.5%). Endovenous laser ablation was successful in 76% (35/46) with the first laser treatment of incompetent perforator veins and 15.2% (7/46) additional ablation procedures were performed. Of the 46 treated IPVs, 42 (91.3%) were occluded on the duplex examination at 12 months. The average energy administrated per perforating vein treated was 162 joule. Two patients reported localized paresthesia, which subsided spontaneously, but no deep venous thrombosis or skin burn was observed. Conclusion Especially in the case of liposclerotic or ulcerated skin in the affected region, PAP of IPVs is highly effective, safe, and appears to be feasible. Patients with active venous ulcers appear to benefit from EVLA of incompetent perforators in order to reduce the risk of ulcer recurrence.

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Patency of Anterior Accessory Saphenous Vein Following Endovenous Laser Ablation for Varicose Veins: Bare-Tip Versus Radial Fiber

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.06.770 ◽

2019 ◽

Vol 58 (6) ◽

pp. e200-e201

Author(s):

Tsuyoshi Shimizu ◽

Ayaka Shiraishi ◽

Rie Horiuchi

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Varicose Veins ◽

Endovenous Laser Ablation ◽

Radial Fiber

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Comparison of Bare-Tip and Radial Fiber in Endovenous Laser Ablation with 1470 nm Diode Laser

Annals of Vascular Diseases ◽

10.3400/avd.oa.14-00081 ◽

2014 ◽

Vol 7 (3) ◽

pp. 239-245 ◽

Cited By ~ 30

Author(s):

Masayuki Hirokawa ◽

Nobuhisa Kurihara

Keyword(s):

Laser Ablation ◽

Diode Laser ◽

Endovenous Laser Ablation ◽

Radial Fiber

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Endovenous laser ablation of insufficient perforating veins: Energy is key to success

Vascular ◽

10.1177/1708538115587214 ◽

2015 ◽

Vol 24 (2) ◽

pp. 144-149 ◽

Cited By ~ 7

Author(s):

Doeke Boersma ◽

Daan LJ Smulders ◽

Olaf J Bakker ◽

Ronald FF van den Haak ◽

Bart AN Verhoeven ◽

...

Keyword(s):

Laser Ablation ◽

Success Rate ◽

Duplex Ultrasound ◽

Endovenous Laser Ablation ◽

Intention To Treat ◽

Perforating Veins ◽

Anatomical Success

Objective To evaluate the feasibility and anatomical success of endovenous laser ablation (EVLA) of incompetent perforating veins (IPV). Methods All 135 consecutive patients with IPV treated with ELVA (intention-to-treat) from January 2008 to December 2013 were included. Up to the end of 2011, an 810-nm laserset (14 W) was used, and afterwards, a 1470-nm laserset (6 W) was introduced. Duplex ultrasound was performed at 6 weeks’ follow-up to assess anatomical success. Results Overall anatomical success at 6 weeks’ follow-up was 56%. Anatomical success was 63% after treatment with 810 nm and 45% with 1470 nm ( p = 0.035). This difference in the success rate seems associated with the significantly higher amount of energy delivered in the 810 nm cohort (560 J) versus 1470 nm (186 J). Regardless of the type of laser, anatomical success was significantly higher after treatment with more than 400 J (66%) compared with 0–200 J (40%, p = 0.009) and 200–400 J (43%, p = 0.029). Complications were limited to two cases of transient paresthesia. Conclusions EVLA of IPVs is safe and feasible. The amount of energy is highly important in achieving anatomical success.

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