title: Endoluminal laser delivery mode and wavelength effects on varicose veins in an ex vivo model.
abstract: OBJECTIVE
  Endovenous laser ablation (EVLA) has been shown to be effective for the elimination of saphenous veins and associated reflux. Mechanism is known to be heat related, but precise way in which heat causes vein ablation is not completely known. This study aimed to determine the effects of various endovenous laser wavelengths and delivery modes on ex vivo human vein both macroscopically and microscopically. We also evaluated whether protected-tip fibers, consisting of prototype silica fibers with a metal tube over the distal end, reduced vein wall perforations compared with non-protected-tip fibers.
  
  
  METHODS
  An ex vivo EVLA model with human veins harvested during ambulatory phlebectomy procedures was used. Six laser fiber combinations were tested: 810 nm continuous wave (CW) diode laser with a flat tip fiber, 810 CW diode laser with a protected tip fiber, 1,320 nm pulsed Nd:YAG laser, 1,310 nm CW diode laser, 1,470 nm CW diode laser, and 2,100 nm pulsed Ho:YAG laser.
  
  
  RESULTS
  Perforation or full thickness necrosis of a portion of the vein wall was observed in 5/11 (45%), 0/11 (0%), 3/22 (14%), 7/11 (64%), 4/6 (67%), and 5/10 (50%) of cross-sections of veins treated with the 810 nm CW diode laser with a flat tip fiber, the 810 CW diode laser with a protected tip fiber, the 1,320 nm pulsed Nd:YAG laser, the 1,310 nm CW diode laser, the 1,470 nm CW diode laser, and the 2,100 nm pulsed Ho:YAG laser, respectively.
  
  
  CONCLUSIONS
  Our results have shown that the delivery mode, pulsed Nd:YAG versus CW, may be just as important as the wavelength. Therefore, the 1,310 nm CW laser may not be equivalent to the 1,320 nm pulsed laser. In addition, protected 810 nm fibers may be less likely to yield wall perforations than their non-protected counterparts.
authors: Goldman, Butterwick, Fitzpatrick, Groff & Fabi Cosmetic Laser Dermatology, San Diego, California, USA. aneniwa@gmail.com
authors: Ane B M N
authors: AB
authors: Massaki
authors: Monika G
authors: MG
authors: Kiripolsky
authors: Susan P
authors: SP
authors: Detwiler
authors: Mitchel P
authors: MP
authors: Goldman
mesh_terms: D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D066298:In Vitro Techniques; D054023:Lasers, Semiconductor / Q000627:therapeutic use*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D016037:Single-Blind Method; D016896:Treatment Outcome; D014648:Varicose Veins / Q000473:pathology / Q000601:surgery*