title: 940-nm laser for treatment of saphenous insufficiency: histological analysis and long-term follow-up.
abstract: OBJECTIVE
  Currently, many methods are available for the treatment of saphenous insufficiency. Modalities available include surgery, sclerotherapy, and radiofrequency closure. Recently, a method has been introduced using laser energy for the treatment of the saphenous vein using a bare-tipped fiber. Our experience using the 940-nm wavelength forms the basis of this report.
  
  
  METHODS
  Indications for treatment with laser obliteration alone was saphenous insufficiency, a saphenofemoral junction of less than 15 mm in diameter and absence of concurrent anticoagulation therapy. Ninety-two percent of the patients were in Class C-2 to C-4, and 8% were in C-5 to C-6. Eight percent had a concurrent high ligation of the saphenous vein. Fifteen patients were treated at varying energy levels and time durations for saphenous insufficiency using a bare-tipped fiber and the 940-nm wavelength laser (SkinPulse S by Dornier). These patients then had histologic evaluation of the treated vein. An additional 620 patients were subsequently treated for saphenous insufficiency using the 940- nm wavelength laser.
  
  
  RESULTS
  At 1-sec pulse durations, histologic studies reveal endothelium and subendothelial damage as the initial response to laser damage. At 3 months, endothelium was still absent, with organized thrombus in the lumen. At 6 months, at 1-sec pulse duration, thrombus organization was still present with evidence of muscle wall damage. Ultrasound evaluation revealed gradual diminution in saphenous vein diameter over 6 months, with absence of reflux and normal flow at the saphenofemoral junction in 95% of patients. For pulse durations of greater than 1 sec, there was transmural injury.
  
  
  CONCLUSIONS
  Laser treatment of the saphenous vein was associated with no complications in our series of patients. The vein remained closed in 95% of those treated. This technique may replace other treatment modalities in up to 90% of patients.
authors.affiliation: Midwest Vein Treatment Clinic, Inc., Centerville, Ohio, USA. veincenters@sbcglobal.net
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Bush
authors.forename: H Nicholas
authors.initials: HN
authors.lastname: Shamma
authors.forename: Karin A
authors.initials: KA
authors.lastname: Hammond
mesh_terms: D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D012501:Saphenous Vein / Q000473:pathology* / Q000601:surgery*; D014648:Varicose Veins / Q000473:pathology / Q000601:surgery*; D014689:Venous Insufficiency / Q000601:surgery*