title: Endovenous Laser Ablation of Perforating Veins: Feasibility, Safety, and Occlusion Rate Using a 1,470-nm Laser and Bare-Tip Fiber.
abstract: OBJECTIVE
  To describe technical feasibility and safety of perforating vein ablation with the use of a 1,470-nm laser and bare-tip fiber in the management of chronic venous insufficiency (CVI).
  
  
  METHODS
  A total of 171 perforating veins were ablated in 101 limbs of 87 patients (mean age, 54.4 y; 79% female). Outcomes included sonographic occlusion of ablated perforator, subjective changes of insufficiency symptoms, incidence of procedure-related side effects (pain, hyperpigmentation), and complications (burn, infection, deep vein thrombosis, paresthesia). Correlation between perforator closure and patient symptoms was assessed by Pearson χ(2) test. Factors influencing failure of perforator closure were analyzed by analysis of variance.
  
  
  RESULTS
  Forty-nine perforating veins had previous great saphenous vein (GSV) interruption, 25 had previous small saphenous vein (SSV) interruption, 88 had previous GSV and SSV interruption, and 9 had competent saphenous systems. Ninety-one ablations were combined with microphlebectomy, 55 were combined with sclerotherapy, and 25 were performed alone. At 1 and 3 months' follow-up, 94% and 98% of ablated perforators were sonographically occluded, and 82% and 96% of patients noted complete symptom resolution, respectively. Complications included 5 cases of new-onset paresthesia and 1 case of nonocclusive deep vein thrombosis. Ablation failed in 10 perforators, and treatment failure showed significant correlations with higher clinical, etiology, anatomy, and physiology score (P = .002) and history of GSV/SSV interruption (P = .042).
  
  
  CONCLUSIONS
  Three-month closure of perforating veins is achievable by using a 1,470-nm laser and bare-tip fiber and can be safely performed alone or in combination with microphlebectomy or sclerotherapy at all stages of CVI severity.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Oakland University William Beaumont School of Medicine, 3601 W. 13 Mile Rd., 2 Center, Royal Oak, MI 48073.. Electronic address: moe.chehab@beumont.edu.
authors.forename: Monzer
authors.initials: M
authors.lastname: Chehab
authors.affiliation: Department of Diagnostic and Interventional Radiology, Oakland University William Beaumont School of Medicine, 3601 W. 13 Mile Rd., 2 Center, Royal Oak, MI 48073.
authors.forename: Purushottam
authors.initials: P
authors.lastname: Dixit
authors.affiliation: Department of Diagnostic and Interventional Radiology, Oakland University William Beaumont School of Medicine, 3601 W. 13 Mile Rd., 2 Center, Royal Oak, MI 48073.
authors.forename: Elias
authors.initials: E
authors.lastname: Antypas
authors.affiliation: Department of Diagnostic and Interventional Radiology, Oakland University William Beaumont School of Medicine, 3601 W. 13 Mile Rd., 2 Center, Royal Oak, MI 48073.
authors.forename: Mare
authors.initials: M
authors.lastname: Juncaj
authors.affiliation: Department of Diagnostic and Interventional Radiology, Oakland University William Beaumont School of Medicine, 3601 W. 13 Mile Rd., 2 Center, Royal Oak, MI 48073.
authors.forename: Oliver
authors.initials: O
authors.lastname: Wong
authors.affiliation: Department of Diagnostic and Interventional Radiology, Oakland University William Beaumont School of Medicine, 3601 W. 13 Mile Rd., 2 Center, Royal Oak, MI 48073.
authors.forename: Michael
authors.initials: M
authors.lastname: Bischoff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation*; D007834:Lasers; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015911:Sclerotherapy; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D062666:Vascular Access Devices; D014689:Venous Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult