Robert Min, Director of the Cornell Vascular Weill Medical College of Cornell University, New York, reported long-term follow-up results of endovenous laser treatment for saphenous vein and junctional tributary reflux at the 2003 UIP World Congress Chapter Meeting held in San Diego, California.
Follow-up results were obtained in 701 limbs in 610 subjects treated with 810nm diode laser energy (Diomed Inc) delivered intraluminally. This group included 566 great saphenous veins (GSVs), 65 small saphenous veins (SSVs) and 70 anterior-lateral tributaries (ALTs).
All veins were accessed percutaneously using ultrasound guidance. Tumescent anaesthesia (100ml to 200ml of 0.2% lidocaine) was delivered perivenously under sonographic guidance. Patients were evaluated clinically and with duplex ultrasound at one week, one month, three months, six months, 12 months, and yearly thereafter to assess treatment efficacy and adverse reactions.
Min said that successful occlusion, defined as absence of flow on colour Doppler, was noted in 686/701 (98%) treated veins at up to 36-month follow-up examination. Of the 223 limbs followed to at least two years, 208 (93%) have remained closed. According to Min, continued closure has been demonstrated in 72 limbs followed to three years. No new recurrences were found at two-year or three-year follow-up that were not present at one year. There have been no skin burns, paresthesias or DVTs.
Min stated that the two-year follow-up results on 223 incompetent GSVs, SSVs, and ALTs treated with endovenous laser demonstrate a recurrence rate of less than 7%. These results are comparable or superior to those reported for the other options available for treatment of saphenous vein or junctional tributary reflux.
“It’s one thing to say that varicose veins are still closed two months after treatment. It’s much more powerful to say that we’ve been doing this for several years – and our results are better than surgery,” emphasised Min.
Min developed endovenous laser therapy (EVLT). The procedure involves injecting a local anaesthetic under ultrasound guidance, inserting a catheter and laser fibre through a small skin incision and continuously delivering laser energy along the entire length of the blood vessel wall.
“You don’t need a big access site to introduce the laser fibre and deliver sufficient amount of targeted heat to close the vein, which is the ultimate goal of the treatment,” said Min. EVLT offers lower rates of complication and avoids general anaesthesia. The most common treatment for varicose veins that cause symptoms has been surgical ligation and stripping, in which the veins are tied shut and completely removed from the leg. This requires anaesthesia and multiple incisions, which often leave scars, and interference with small branches of sensory nerves is difficult to avoid.
Compared to existing minimally invasive endovenous techniques such as transcatheter sclerotherapy or radiofrequency ablation, Min says that endovenous laser has the following potential advantages:
Transmission of energy through a small diameter, flexible fibre allows treatment of a wider range of vein types and sizes, while minimising access site size.
Faster rates of withdrawal and shallow depth of penetration of 810nm laser energy may result in less damage to surrounding non-target tissue compared to radiofrequency.
Lower disposable treatment costs compared to radiofrequency catheter ablation.
Patients with pacemakers are not excluded from treatment.
Avoidance of the risk of intra-arterial injection and minimal risk of anaphylaxis compared to ultrasound-guided sclerotherapy.
Precise control of vein wall damage may lead to lower rates of recanalisation compared to chemical closure (i.e. sclerotherapy).
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