title: Endovenous laser ablation of the great saphenous vein with a 980-nm diode laser in continuous mode: early treatment failures and successful repeat treatments.
abstract: OBJECTIVE
  To investigate the efficacy of lower-energy endovenous laser treatment for great saphenous vein (GSV) incompetence and treatment parameters associated with early treatment failure.
  
  
  METHODS
  Sixty consecutive endovenous laser treatments (32 left, 28 right; 57 initial treatments, three repeat treatments) in 48 patients (13 men, 35 women; mean age, 55.2 +/- 12.9 years), with bilateral treatments in nine patients, were studied. Preprocedural clinical signs, etiology, anatomy, and physiologic classifications demonstrated class 2 limbs in 11.7% of cases, class 3 limbs in 25.0%, class 4 limbs in 48.3%, and class 5 limbs in 15.0%. All initial and repeat treatments were performed with lower-energy with use of a 980-nm diode endovenous laser at 11 W in continuous mode. Patients wore class II compression stockings for 2 weeks and were followed up at 1, 3, and 6 months with clinical and duplex ultrasound examinations. Treatment failures were diagnosed at 3 months on the basis of GSV patency or lack of clinical improvement. Diameter and length of GSV treated, treatment energy parameters, and clinical outcomes were prospectively measured and compared between successful and failed treatments.
  
  
  RESULTS
  The initial treatment success rate was 94.7% (54 of 57). The mean maximum diameter of successfully treated GSVs was 1.12 +/- 0.52 cm, and the mean maximum diameter of GSVs in which treatment failure occurred was 2.05 +/- 0.23 cm (P = .008). Mean total energy applied for successful treatments was 1,131.3 +/- 248.1 J, and mean total energy applied for failed treatments was 1,439.6 +/- 425.0 J (P = 0.053). Mean unit energy applied for successful treatments was 32.7 +/- 7.5 J/cm, and that for failed treatments was 32.8 +/- 4.9 J/cm (P = .986). All patients in whom treatment failed were successfully treated again with a mean total energy of 1,393.0 +/- 81.0 J and a mean unit energy of 29.4 +/- 4.9 J/cm. There were no significant differences in mean total energy or unit energy applied among successful, failed, and repeat treatments (P > .05). Mean follow-up duration was 6.8 months.
  
  
  CONCLUSIONS
  Endovenous laser treatment with lower energy appears to be safe and effective. Larger GSV diameter is associated with early treatment failures.
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 545, Baltimore, Maryland 21205, USA. sikhkim@jhmi.edu
authors.forename: Hyun S
authors.initials: HS
authors.lastname: Kim
authors.forename: Ben E
authors.initials: BE
authors.lastname: Paxton
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*