New wavelength for the endovascular treatment of lower limb venous insufficiency.
OBJECTIVE
The aim of this research was to show the efficacy of the 1 470-nm wavelength diode laser for endovenous laser treatments and the clinical results obtained.


METHODS
Patients with varicose veins stratified by CEAP classification (clinical) in C2-6 and low-flow venous malformations were treated with and without crossectomy. Endolaser venous system with Ceralas E 1 470 nm diode laser (ELVeS PainLess, Biolitec AG, Jena, Germany) was used. The average power applied was in the range of 2-6 W, continuous mode and pull-back of 10 mm/5 s. Two optical fibres were used; frontal emission bare fibre of 400 micro (ELVeS) and radial emission fibre of 600 micro (ELVeS). All patients were evaluated with Duplex ultrasonography (US) before, intraproceeding, immediately after, at 48 hours, 7 and 30 days after the initial procedure. An average follow-up of twelve months was attained. In 15% of the cases, the endovenous laser proceeding was also evaluated during the treatment with thermographic images, direct thermography and direct venous angioscopy to assess the local temperature increase. After the treatment histopathological studies were also performed.


RESULTS
Between 30% and 50% of the vein's initial diameter was immediately reduced in 100% of patients and fibrosis was observed by histopathological analysis. Thirty days post-treatment all cases presented venous obliteration observed by Duplex US. Clinical symptoms were resolved. Side-effects were: minimal discomfort, local pain, postpuncture ecchymosis and minimal fibrosis of the treated veins. Nevertheless, there was absence of hyperpigmentation in all patients and absence of neuritis in 98.6% of patients. Popliteal thrombosis was presented 24 hours after the procedure in 2.9% of the patients (these patients did not receive heparin).


CONCLUSIONS
With this laser wavelength, which is new in phlebology applications, remarkable effective results were achieved with lower power comparing to the results currently obtained by using higher power and shorter laser wavelengths. This development provides the benefit of potentially better therapeutic results with less collateral damage.
Soracco
J E
JE
Phlebology Private Centre, Buenos Aires, Argentina. jsoracco@fibertel.com.ar
D'Ambola
J O López
JO
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017546:Angioscopy; D001118:Argentina; D004867:Equipment Design; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation; D054023:Lasers, Semiconductor; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D013817:Thermography; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*