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EVALUATION OF THE EFFICACY OF ENDOVENOUS LASER ABLATION THERAPY FOR PATIENTS WITH LOWER LIMB CHRONIC SAPHENOUS AND PERFORATING VEIN INSUFFICIENCY

Year 2023, Volume: 4 Issue: Ek Sayı, 180 - 187, 16.10.2023

Abstract

Introduction: Chronic venous insufficiency (CVI) in the lower extremities is a widely observed disease in society. In these patients, endovenous laser ablation (EVLA) treatment, which has been considered highly effective and minimally invasive since 2001, is used in addition to other treatments. In this method, thermal ablation is created by intervention under ultrasound imaging (USG) guidance on the veins identified with color Doppler ultrasonography (CDUS) to have insufficiency. Within a short period, irreversible damage is induced in the vein, leading to autoinhibition and the alleviation of CVI symptoms. Hospitalization is not required for the patient, and they can mobilize with elastocompressive support.
Methods: Our study included 50 patients (89 veins, 71 legs) who were diagnosed with chronic venous insufficiency and classified according to the CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification between March 2008 and August 2009. Patients who did not have contraindications for EVLA were included. The procedure was performed using a device with a 980 nm wavelength and a 400- micron fiber-optic tip. Additionally, patients with a high number of varices underwent complementary treatment with sclerotherapy targeting superficial veins.
Results: During the five to twenty months of clinical and Doppler follow-ups, among the 89 veins subjected to laser treatment, permanent complete occlusion was observed in 87%, symptomatic recanalization in 6.5%, and asymptomatic recanalization in 6.5%. Procedure-related major complications occurred in 3 patients, and minor complications occurred in 45 patients.
Conclusion: Excluding patients with symptomatic recanalization, the treatment success rate was accepted as 94.5%, consistent with the literature. Consequently, in this prospective study, EVLA was found to be an effective, safe, and advantageous method in terms of patient comfort, rapidly replacing surgery in the treatment of CVI.

References

  • 1. Earnshaw JJ. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial. J Vasc Surg 1999; 29: 589-92.
  • 2. Mani BC, Delgado GA. Varicose Veins Radiofrequency Ablation Therapy. Treasure Island (FL): StatPearls Publishing;.2022 Sep 26.
  • 3. Karam B, Moussally M, Nassar H, Ataya K, Jaafar R, Haddad F. Long-term results of endovenous laser ablation of saphenous vein reflux: Up to nine years of follow-up. Phlebology. 2021; 36:43-7.
  • 4. Navarro L, Min RJ, Bone C. Endovenous laser: a new minimally invasive method of treatment for varicose veins: preliminary observations using an 810 nm diode laser. Dermatol Surg 2001; 27:117–22.
  • 5. Santler B, Goerge T. Chronic venous insufficiency-a review of pathophysiology, diagnosis, and treatment. J Dtsch Dermatol Ges. 2017; 15:538-56.
  • 6. Aktas AR, Celik O, Ozkan U et al. Comparing 1470- and 980-nm diode lasers for endovenous ablation treatments. Comparative Study Lasers Med Sci. 2015; 30:1583-7.
  • 7. Vasquez MA, Wang J, Mahathanaruk M, Buczkowski G, Sprehe E, Dostluoğlu HH. The utility of the venous clinical severity score in 682 limbs treated by radiofrequency saphenous vein ablation, J Vasc Surg. 2007; 45:1008-15.
  • 8. Radhakrishnan N, George D, Jayakrishnan R, Sumi S, Kartha CC. Vein Size and Disease Severity in Chronic Venous Diseases. Int J Angiol. 2018; 27: 185-9.
  • 9. Gibson K, Meissner M, Wright D. Great saphenous vein diameter does not correlate with worsening quality of life scores in patients with great saphenous vein incompetence. J Vasc Surg.2012;56:1634-41.
  • 10. Van Bemmelen PS, Bedford G, Beach K, Strandness DE. Quantative segmental evaluation of venous valvular reflux with DUS ultrasound scanning. J Vasc Surg 1989; 10:425-31.
  • 11. Evans CJ, Allan PL, Lee AJ, et al. Prevelance of venous reflux in the general population on DUS scanning; the Edinburg vein study. J Vasc Surg 1998; 28:767-76.
  • 12. Labropoulos N, Tiongson J, Pryor L, et al. Definition of venous reflux in lower-extremity veins. J Vasc Surg. 2003; 38:793-8.
  • 13. Sarin S, Scurr JH, Coleridge Smith PD. Medial calf perforators in venous dissease: the significance of outward flow. J Vasc Surg 1992; 16:40-6.
  • 14. Sandri JL, Barros FS, Pontes S, Jacques C, Salles-Cunha SX. Diameter-reflux relationship in perforating veins of patients with varicose veins. J Vasc Surg. 1999; 30:867-74.
  • 15. Tessari L, Cavezzi A, Frullini A. Preliminary Experience with a New Sclerosing Foam in the Treatment of Varicose Veins. Dermatol Surg 2001; 27: 58-60.
  • 16. Dexter D, Kabnick L, Berland T, et al. Complications of endovenous lasers. Phlebology. 2012;27:40-45.
  • 17. Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011; 53:2S-48S.
  • 18. De Mederios CA, Luccas GC. Comparison of endovenous treatment with an 810 nm laser versus conventional stripping of the great saphenous vein in patients with primary varicose veins. Dermatol Surg 2005; 31:1685-94.
  • 19. Sarin S, Scurr JH, Coleridge Smith PD. Assessment of stripping the long saphenous vein in the treatment of primary varicose veins. Br J surg 1992; 79: 889-93.
  • 20. Gauw SA, Lawson JA, Vlijmen-van Keulen CJ, Pronk P, Gaastra MTW, Mooij MC. Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg 2016; 63:420-8.
  • 21. Eggen CAM, Alozai T, Pronk P, et al. Ten-year follow-up of a randomized controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg Venous Lymphat Disord. 2022; 10:646-53.
  • 22. Gulek B, Arslan M, Sozutok S. Results of a long-term performance and follow-up of Endovenous Laser Ablation procedures performed for treating great saphenous vein incompetence. Pak J Med Sci. 2018; 34: 1332-35.
  • 23. Paravastu SCV, Horne M, Dodd PDF. Endovenous ablation therapy (laser or radiofrequency) or foam sclerotherapy versus conventional surgical repair for short saphenous varicose veins. Cochrane Database Syst Rev. 2016; 11: CD010878.
  • 24. Stuart WP, Adam DJ, Allan PL, et al. The relationship between the number, competence, and diameter of medial calf perforating veins and the clinical status in healthy subjects and patients with lower-limb venous disease. J Vasc Surg.2000; 32:138-43.
  • 25. Hager ES, Washington C, Steinmetz A, Wu T, Singh M, Dillavou E. Factors that influence perforator vein closure rates using radiofrequency ablation, laser ablation, or foam sclerotherapy. J Vasc Surg. 2016; 4:51-6.
  • 26. Woodburn KR. Endothermal ablation for the treatment of clinically significant incompetent lower limb perforating veins: factors influencing the early outcomes. Phlebology. 2021; 36:127-134.
  • 27. Timperman PE. Prospective evaluation of higher energy great saphenous vein endovenous laser treatment. J Vasc Interv Radiol. 2005; 16: 791-94.
  • 28. Kabnick L. Outcome of different endovenous laser wavelengths for great saphenous vein ablation. J Vasc Surg. 2006; 43: 88-93.
  • 29. Pave P, Spreafico G, Bernardi E, Giraldi E, Ferrini M. Favorable long-term results of endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber. J Vasc Surg Venous Lymphat Disord. 2021; 9(2):352-60
  • 30. Proebstle TM, Gül D, Kargl A, et al. Non-occlusion and early reopening of the great saphenous vein after endovenous laser treatment is fluence dependent. Dermatol Surg. 2004; 30: 174-78.
  • 31. Hudson AJ, Whittaker DR, Szpisjak DF, Lenart MJ, Bailey MM. Tumescent technique without epinephrine for endovenous laser therapy and serum lidocaine concentration. J Vasc Surg Venous Lymphat Disord. 2015; 3:48-53.
  • 32. Hirokawa M, Sugano N, Inoue Y, et al. A Novel Endovenous Laser Treatment of Great Saphenous Vein Reflux with a 1320 nm Nd: YAG Laser. and a Pull-back Device Nakashima and T. Iwa Dermatol Surg. 2005; 241-44.

ALT EKSTREMiTEDE KRONiK SAFEN VE PERFORAN VEN YETMEZLİĞİ BULUNAN HASTALARDA ENDOVENÖZ LAZER ABLASYON TEDAViSiNiN ETKiNLiĞiNiN DEĞERLENDiRiLMESi

Year 2023, Volume: 4 Issue: Ek Sayı, 180 - 187, 16.10.2023

Abstract

Giriş: Alt ekstremitede kronik venöz yetmezlik (KVY), toplumda çok yaygın olarak izlenen bir hastalıktır. Bu hastalarda, 2001 yılından beri oldukça etkili ve minimal invaziv işlem olarak kabul edilen endovenöz lazer ablasyon (EVLA) tedavisi diğer tedavilere ek olarak kullanılmaktadır. Bu yöntemde; renkli Doppler ultrasonografi (RDUS) ile yetmezlik saptanan damarlara ultrason görüntüleme (USG) eşliğinde girişim yapılarak termal ablasyon oluşturulur. Kısa zaman içinde; damarda oluşturulan geri dönüşümsüz hasar sebebiyle otoinhibisyon gelişir ve KVY semptomları giderilmiş olur. Hastaya yatış gerekmez ve hasta elasto-kompresyon uygulanarak mobilize olabilir.
Yöntemler: Çalışmamıza; Mart 2008 ve Ağustos 2009 tarihleri arasında, CEAP (Clinical-Etiology-Anatomy-Pathophysiology) sınıflamasına göre derecelendirilen kronik venöz yetmezlik saptanan ve EVLA için kontrendikasyonu bulunmayan 50 hasta dahil edildi (89 damar, 71 bacak). Prosedür; 980 nm dalga boylu, 400 mikron fiberoptik başlıklı cihaz ile gerçekleştirildi. Ayrıca varisleri çok olan hastalara, tamamlayıcı tedavi olarak, yüzeysel damarlara yönelik skleroterapi de yapıldı.
Bulgular: Beş-yirmi aylık klinik ve Doppler takiplerinde; lazer uygulanan 89 damarın, %87’sinde kalıcı tam oklüzyon, %6,5’inde semptomatik, %6,5’inde asemptomatik rekanalizasyon saptandı. İşleme bağlı olarak 3 hastada majör, 45 hastada minör komplikasyon gelişti.
Sonuç: Semptomatik rekanalizasyon gelişen hastalar çıkarıldığında, tedavi başarısı, literatür ile uyumlu olarak %94,5 kabul edilmiştir. Sonuç olarak; bu prospektif çalışmada, EVLA yönteminin KVY tedavisinde etkili, güvenli ve hasta konforu açısından avantajlı olduğu için artan bir hızla cerrahinin yerini alan bir yöntem olduğu sonucuna varılmıştır.

References

  • 1. Earnshaw JJ. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial. J Vasc Surg 1999; 29: 589-92.
  • 2. Mani BC, Delgado GA. Varicose Veins Radiofrequency Ablation Therapy. Treasure Island (FL): StatPearls Publishing;.2022 Sep 26.
  • 3. Karam B, Moussally M, Nassar H, Ataya K, Jaafar R, Haddad F. Long-term results of endovenous laser ablation of saphenous vein reflux: Up to nine years of follow-up. Phlebology. 2021; 36:43-7.
  • 4. Navarro L, Min RJ, Bone C. Endovenous laser: a new minimally invasive method of treatment for varicose veins: preliminary observations using an 810 nm diode laser. Dermatol Surg 2001; 27:117–22.
  • 5. Santler B, Goerge T. Chronic venous insufficiency-a review of pathophysiology, diagnosis, and treatment. J Dtsch Dermatol Ges. 2017; 15:538-56.
  • 6. Aktas AR, Celik O, Ozkan U et al. Comparing 1470- and 980-nm diode lasers for endovenous ablation treatments. Comparative Study Lasers Med Sci. 2015; 30:1583-7.
  • 7. Vasquez MA, Wang J, Mahathanaruk M, Buczkowski G, Sprehe E, Dostluoğlu HH. The utility of the venous clinical severity score in 682 limbs treated by radiofrequency saphenous vein ablation, J Vasc Surg. 2007; 45:1008-15.
  • 8. Radhakrishnan N, George D, Jayakrishnan R, Sumi S, Kartha CC. Vein Size and Disease Severity in Chronic Venous Diseases. Int J Angiol. 2018; 27: 185-9.
  • 9. Gibson K, Meissner M, Wright D. Great saphenous vein diameter does not correlate with worsening quality of life scores in patients with great saphenous vein incompetence. J Vasc Surg.2012;56:1634-41.
  • 10. Van Bemmelen PS, Bedford G, Beach K, Strandness DE. Quantative segmental evaluation of venous valvular reflux with DUS ultrasound scanning. J Vasc Surg 1989; 10:425-31.
  • 11. Evans CJ, Allan PL, Lee AJ, et al. Prevelance of venous reflux in the general population on DUS scanning; the Edinburg vein study. J Vasc Surg 1998; 28:767-76.
  • 12. Labropoulos N, Tiongson J, Pryor L, et al. Definition of venous reflux in lower-extremity veins. J Vasc Surg. 2003; 38:793-8.
  • 13. Sarin S, Scurr JH, Coleridge Smith PD. Medial calf perforators in venous dissease: the significance of outward flow. J Vasc Surg 1992; 16:40-6.
  • 14. Sandri JL, Barros FS, Pontes S, Jacques C, Salles-Cunha SX. Diameter-reflux relationship in perforating veins of patients with varicose veins. J Vasc Surg. 1999; 30:867-74.
  • 15. Tessari L, Cavezzi A, Frullini A. Preliminary Experience with a New Sclerosing Foam in the Treatment of Varicose Veins. Dermatol Surg 2001; 27: 58-60.
  • 16. Dexter D, Kabnick L, Berland T, et al. Complications of endovenous lasers. Phlebology. 2012;27:40-45.
  • 17. Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011; 53:2S-48S.
  • 18. De Mederios CA, Luccas GC. Comparison of endovenous treatment with an 810 nm laser versus conventional stripping of the great saphenous vein in patients with primary varicose veins. Dermatol Surg 2005; 31:1685-94.
  • 19. Sarin S, Scurr JH, Coleridge Smith PD. Assessment of stripping the long saphenous vein in the treatment of primary varicose veins. Br J surg 1992; 79: 889-93.
  • 20. Gauw SA, Lawson JA, Vlijmen-van Keulen CJ, Pronk P, Gaastra MTW, Mooij MC. Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg 2016; 63:420-8.
  • 21. Eggen CAM, Alozai T, Pronk P, et al. Ten-year follow-up of a randomized controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg Venous Lymphat Disord. 2022; 10:646-53.
  • 22. Gulek B, Arslan M, Sozutok S. Results of a long-term performance and follow-up of Endovenous Laser Ablation procedures performed for treating great saphenous vein incompetence. Pak J Med Sci. 2018; 34: 1332-35.
  • 23. Paravastu SCV, Horne M, Dodd PDF. Endovenous ablation therapy (laser or radiofrequency) or foam sclerotherapy versus conventional surgical repair for short saphenous varicose veins. Cochrane Database Syst Rev. 2016; 11: CD010878.
  • 24. Stuart WP, Adam DJ, Allan PL, et al. The relationship between the number, competence, and diameter of medial calf perforating veins and the clinical status in healthy subjects and patients with lower-limb venous disease. J Vasc Surg.2000; 32:138-43.
  • 25. Hager ES, Washington C, Steinmetz A, Wu T, Singh M, Dillavou E. Factors that influence perforator vein closure rates using radiofrequency ablation, laser ablation, or foam sclerotherapy. J Vasc Surg. 2016; 4:51-6.
  • 26. Woodburn KR. Endothermal ablation for the treatment of clinically significant incompetent lower limb perforating veins: factors influencing the early outcomes. Phlebology. 2021; 36:127-134.
  • 27. Timperman PE. Prospective evaluation of higher energy great saphenous vein endovenous laser treatment. J Vasc Interv Radiol. 2005; 16: 791-94.
  • 28. Kabnick L. Outcome of different endovenous laser wavelengths for great saphenous vein ablation. J Vasc Surg. 2006; 43: 88-93.
  • 29. Pave P, Spreafico G, Bernardi E, Giraldi E, Ferrini M. Favorable long-term results of endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber. J Vasc Surg Venous Lymphat Disord. 2021; 9(2):352-60
  • 30. Proebstle TM, Gül D, Kargl A, et al. Non-occlusion and early reopening of the great saphenous vein after endovenous laser treatment is fluence dependent. Dermatol Surg. 2004; 30: 174-78.
  • 31. Hudson AJ, Whittaker DR, Szpisjak DF, Lenart MJ, Bailey MM. Tumescent technique without epinephrine for endovenous laser therapy and serum lidocaine concentration. J Vasc Surg Venous Lymphat Disord. 2015; 3:48-53.
  • 32. Hirokawa M, Sugano N, Inoue Y, et al. A Novel Endovenous Laser Treatment of Great Saphenous Vein Reflux with a 1320 nm Nd: YAG Laser. and a Pull-back Device Nakashima and T. Iwa Dermatol Surg. 2005; 241-44.
There are 32 citations in total.

Details

Primary Language Turkish
Subjects Health Services and Systems (Other)
Journal Section Research Articles
Authors

Zeynep Güvenç 0000-0003-2406-4861

Cüneyt Aytekin 0000-0002-8711-3862

Fatih Boyvat 0000-0002-0076-9034

Umut Özyer 0000-0002-4300-009X

Ali Harman 0000-0002-7386-7110

Early Pub Date October 16, 2023
Publication Date October 16, 2023
Published in Issue Year 2023 Volume: 4 Issue: Ek Sayı

Cite

APA Güvenç, Z., Aytekin, C., Boyvat, F., Özyer, U., et al. (2023). ALT EKSTREMiTEDE KRONiK SAFEN VE PERFORAN VEN YETMEZLİĞİ BULUNAN HASTALARDA ENDOVENÖZ LAZER ABLASYON TEDAViSiNiN ETKiNLiĞiNiN DEĞERLENDiRiLMESi. Eskisehir Medical Journal, 4(Ek Sayı), 180-187.
AMA Güvenç Z, Aytekin C, Boyvat F, Özyer U, Harman A. ALT EKSTREMiTEDE KRONiK SAFEN VE PERFORAN VEN YETMEZLİĞİ BULUNAN HASTALARDA ENDOVENÖZ LAZER ABLASYON TEDAViSiNiN ETKiNLiĞiNiN DEĞERLENDiRiLMESi. Eskisehir Med J. October 2023;4(Ek Sayı):180-187.
Chicago Güvenç, Zeynep, Cüneyt Aytekin, Fatih Boyvat, Umut Özyer, and Ali Harman. “ALT EKSTREMiTEDE KRONiK SAFEN VE PERFORAN VEN YETMEZLİĞİ BULUNAN HASTALARDA ENDOVENÖZ LAZER ABLASYON TEDAViSiNiN ETKiNLiĞiNiN DEĞERLENDiRiLMESi”. Eskisehir Medical Journal 4, no. Ek Sayı (October 2023): 180-87.
EndNote Güvenç Z, Aytekin C, Boyvat F, Özyer U, Harman A (October 1, 2023) ALT EKSTREMiTEDE KRONiK SAFEN VE PERFORAN VEN YETMEZLİĞİ BULUNAN HASTALARDA ENDOVENÖZ LAZER ABLASYON TEDAViSiNiN ETKiNLiĞiNiN DEĞERLENDiRiLMESi. Eskisehir Medical Journal 4 Ek Sayı 180–187.
IEEE Z. Güvenç, C. Aytekin, F. Boyvat, U. Özyer, and A. Harman, “ALT EKSTREMiTEDE KRONiK SAFEN VE PERFORAN VEN YETMEZLİĞİ BULUNAN HASTALARDA ENDOVENÖZ LAZER ABLASYON TEDAViSiNiN ETKiNLiĞiNiN DEĞERLENDiRiLMESi”, Eskisehir Med J, vol. 4, no. Ek Sayı, pp. 180–187, 2023.
ISNAD Güvenç, Zeynep et al. “ALT EKSTREMiTEDE KRONiK SAFEN VE PERFORAN VEN YETMEZLİĞİ BULUNAN HASTALARDA ENDOVENÖZ LAZER ABLASYON TEDAViSiNiN ETKiNLiĞiNiN DEĞERLENDiRiLMESi”. Eskisehir Medical Journal 4/Ek Sayı (October 2023), 180-187.
JAMA Güvenç Z, Aytekin C, Boyvat F, Özyer U, Harman A. ALT EKSTREMiTEDE KRONiK SAFEN VE PERFORAN VEN YETMEZLİĞİ BULUNAN HASTALARDA ENDOVENÖZ LAZER ABLASYON TEDAViSiNiN ETKiNLiĞiNiN DEĞERLENDiRiLMESi. Eskisehir Med J. 2023;4:180–187.
MLA Güvenç, Zeynep et al. “ALT EKSTREMiTEDE KRONiK SAFEN VE PERFORAN VEN YETMEZLİĞİ BULUNAN HASTALARDA ENDOVENÖZ LAZER ABLASYON TEDAViSiNiN ETKiNLiĞiNiN DEĞERLENDiRiLMESi”. Eskisehir Medical Journal, vol. 4, no. Ek Sayı, 2023, pp. 180-7.
Vancouver Güvenç Z, Aytekin C, Boyvat F, Özyer U, Harman A. ALT EKSTREMiTEDE KRONiK SAFEN VE PERFORAN VEN YETMEZLİĞİ BULUNAN HASTALARDA ENDOVENÖZ LAZER ABLASYON TEDAViSiNiN ETKiNLiĞiNiN DEĞERLENDiRiLMESi. Eskisehir Med J. 2023;4(Ek Sayı):180-7.