[The endovenous laser therapy of varicose veins--substantial innovation or expensive playing?].
BACKGROUND
The aim of the study was to evaluate the efficiency of the endovenous use of laser for treatment of varicose veins. In particular the influence of laser energy on the perivenous temperature, the postoperative clinical and duplex ultrasound course was taken into account.


METHODS
The patients were divided into two groups. In 33 cases the laser therapy was used without perivenous liquid protection. In 30 cases a 0.9 % NaCl solution has been injected around the vein. The laser used was a 980 nm diode laser (Ceralas D 980, Biolitec AG, Bonn). The pulse-mode procedure has been applied for triggering the laser impulse (1.5 s pulse length, 1.5 s pause with a 3 mm withdrawal of the laser fibre. The laser energy was 15 watt. 20 cm distal to the saphenofemoral or saphenopopliteal junction a thermo unit measured continuously the perivenous temperature. Clinical and duplex ultrasound checks were carried out before and on the day of the operation. Further checks followed on the first and tenth day after the operation and 8 weeks and 6 months afterwards.


RESULTS
The perivenous temperature prior to ELT was 31.3 degrees C, then dropping after the injection of the NaCl solution by 3.4 degrees C. During the ELT the temperature rose by 10.0 degrees C without and by 5.5 degrees C with infiltration. The rise in temperature happened only 3 cm before the tip of the laser fibre arrived at the thermo unit and fell quite rapidly. 98 % of the veins showed within the time period of 2 to 14 months an effective occlusion controlled by duplex ultrasound without refluxing segments. All operations were out-patient treatments. The patients were able to take up work after 1 to 7 days.


CONCLUSIONS
The endovenous laser treatment is an innovative method for the treatment of varicose veins. Considering the mid-term subjective and objective outcomes this method can not only compete with the conventional surgery but has proved to be superior as regards the recurrence rate and patient's comfort. The study presented here, did not find a risk of damage to surrounding non-target tissue.
Lahl
W
W
St. Willehad-Hospital, Gefässchirurgische Abteilung, Ansgaristrasse 12, 26382 Wilhelmshaven. wolfgang.lahl@willehad.de
Hofmann
B
B
Jelonek
M
M
Nagel
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D016342:Angioplasty, Laser / Q000191:economics / Q000379:methods*; D003080:Cold Temperature; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010477:Perfusion; D055502:Secondary Prevention; D012965:Sodium Chloride; D013696:Temperature; D018615:Ultrasonography, Doppler, Color; D014648:Varicose Veins / Q000191:economics / Q000601:surgery*
D012965:Sodium Chloride