Laser therapy endovenous

• The placement of the laser fibre is carried out in Seldinger technique using a guide wire and catheter in sonographic control. A transcutaneously visible red pilot beam of the laser serves as a supplementary control for the correct positioning of the fiber tip (only visible in the darkened operating room).
• After transmission of light energy, blood remaining in the vein absorbs the laser energy and vaporizes. This causes a vapor bubble to form and heat damage to the inner vessel wall. The vascular lumen only closes secondarily in the course of a few hours after the procedure due to a thrombus.
• Commonly used wavelengths of laser light are 810 nm, 940 nm and 980 nm. A minimum energy of 60-80 J/cm vein is recommended.
• For the wavelength 1320 nm, 8 W laser power is currently used, at about 60 J/cm vein.
• Experimental: Good individual results with low postoperative pain intensity were achieved for ELT using a thulium laser (1940 nm) and radial light application.

Postoperative pain in the course of the treated truncal veins is to be expected. They are classified by most patients (about 8o%) as mild to moderate. Approximately 18% of those treated describe severe to very severe pain. Parvenous haematomas are described in about 50% of the patients. Phlebitis of the truncal vein occurs in about 3-17% of the patients treated. Other less frequent complications are dysesthesia, skin burns, pulmonary embolism.

Currently data with 20,000 ELT treatments are available. With adequate patient selection, ELT treatment with successful probing of the truncal vein is technically possible in > than 99% of patients. With meta-analytical workup, an average incidence of non-occlusions or early recanalizations of 2.3% is calculated. In long-term studies (>60 months) recanalizations of > 20% are found.

1. Go SJ et al (2016) Study on the Long-Term Results of Endovenous Laser Ablation for Treating Varicose Veins. Int J Angiol 25:117-120.
2. Han, M et al (2006) Endoluminal catheter-based laser therapy of truncal vein insufficiency. Dermatologist 57: 26-32
3. Min RJ et al (2003) Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc interval Radiol 14: 991-996
4. Nüllen H et al (2010) Surgery of perforators varicosis. In: T Noppeney, H Nüllen Diagnosis and therapy of varicosis. Springer Medicine Publishing House Heidelberg S 349-357
5. Oh CK et al (2003) Endovenous laser surgery of the incompetent greater saphenous vein with a 980-nm diode laser. Dermatol Surgery 29: 1135-1140
6. Proebstle TM, Lehr HA, Kargl A et al (2002) Endovenous treatment of the greater saphenous vein with a 940 nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser generated steam bubbles. J Vasc Surg 35: 729-36
7. Proebstle TM et al (2004) Nonocclusion and early reopening of the great saphenous vein after endovenous laser treatment is fluence dependent. Dermatol Surgery 30: 174-178
8. Schmedt CG et al (2014) First clinical results of endovenous laser therapy with thulium laser (1940 nm) and radial light application. Vasomed 26: 294-295