Endovenous laser coagulation optimal energetic regiment
Abstract
This was a study of endovenous laser (EVLC) coagulation for the treatment of incompetent varicose great saphenous veins (GSVs) with an endovenous diode laser 1470-nm. Two energetic regiments were compared: a laser by continuous emission at 10 W in 104 patients (1st group) and a laser by continuous emission at 15 W in 102 patients (2nd group). Duplex ultrasound (DUS) monitoring was performed during follow-up visits on 7, 14, 21, 28 days, 5th, 6th and 8th weeks to evaluate lumen echogenicy, to detect the presence of blood flow and reflux, and to measure vein diameters, following laser ablation. Initial vein occlusion in both groups was achieved immediately after laser ablation. Mean diameters of the GSV-derived fibrotic cord decreased from the vein diameter 8.1 mmbefore treatment to 6,8 mmat 1 week after intervention and to 5,6 mmat 8 weeks (p<0.001). Reflux was not documented during follow-up. In addition to DUS imaging, clinical findings were evaluated using Venous Clinical Severity Scope (VCSS) at the same time intervals. VCSS estimation on the 8th week has demonstrated greater prevalence of local complications with larger energy (15 W): ecchymosis – 39,4% in the 1st group compared to 50,9% in the 2nd group; pain fibrotic cords - 26,9% in the 1st group compared to 34,3% in the 2nd group; skin hyperpigmentation – 6,8% in the 1st group compared to 18,6 in the 2nd group.
It has been shown that 10 W laser emissions with linear energy density up to 30 J/sec is enough for achieving of fibrotic changes in the vain lumen on all the stripping length with minimising of clinical sings and local complications.Downloads
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