Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.07214
Jornal Vascular Brasileiro
Original Article

Real time echo-guided endolaser for thermal ablation without perivenous tumescence

Endolaser ecoguiado em tempo real para termoablação sem intumescência perivenosa

Ricardo José Gaspar; André Nóbrega Castro; Manuel de Jesus Simões; Hélio Plapler

Downloads: 3
Views: 924

Abstract

Abstract Background There is no consensus in the medical literature on the ideal procedure for endovenous laser application. Objective To assess the safety and efficacy of real time echo-guided endovenous laser for thermal ablation of great saphenous vein (GSV) incompetence, without perivenous tumescence. Methods Thirty-four limbs of patients with CEAP clinical scores of 2 to 6 and bilateral incompetence of the saphenofemoral junction (SFJ) and GSV, confirmed by Echo-Doppler, underwent endovenous laser therapy and were followed for 1 year. Laser ablation was performed using a 600 µ bare optical fiber introduced endovenously close to the malleolus along the full extent of the GSV in an anterograde direction, using a standardized echo-Doppler-guided AND? 15 watt continuous mode 980 nm diode laser with real-time monitoring of thermal ablation of the whole target vein. Adverse effects and complications were recorded. Results Hyperesthesia, cellulitis, and fibrous cord, all transitory, developed in 2.9% of the 34 limbs treated; 8.8% developed hypoesthesia in the perimalleolar region, which was transitory and had no clinical consequences; there were no cases of deep venous thrombosis. Immediate occlusion was achieved in 100% of the 34 saphenous veins that underwent photocoagulation, although one exhibited recanalization without reflux at 1-month follow-up. After 6 months and 1 year, occlusion was 100% according to echo-Doppler findings. Conclusions Real-time echo-guided 980 nm endovenous laser ablation without perivenous tumescence provided controlled thermal ablation with safe, effective, immediate and medium-term GSV occlusion and can therefore be recommended as a method for the treatment of chronic venous disease.

Keywords

varicose veins, venous insufficiency, saphenous vein, laser therapy

Resumo

Resumo Contexto Não há consenso na literatura médica sobre qual técnica é a ideal para aplicação do endolaser. Objetivos Avaliar a segurança e a eficácia do endolaser ecoguiado em tempo real para termoablação da veia safena magna (VSM) insuficiente, sem intumescência perivenosa. Métodos Trinta e quatro membros de pacientes em estágio clínico CEAP 2 a 6, com incompetência bilateral da junção safeno-femoral e da VSM, confirmada por eco-Doppler, foram submetidos à terapia por endolaser e acompanhados por um período de um ano. A aplicação foi feita por meio de fibra condutora de 600 µ, introduzida por via endovenosa, ao nível da região perimaleolar por toda VSM, sentido anterógrado, utilizando laser diodo com 15 w de potência e 980 nm de comprimento de onda, no modo contínuo, guiado por eco-Doppler, e forma padronizada para monitoração em tempo real da termoablação de toda a veia-alvo. Foram anotados os efeitos adversos e as complicações. Resultados Dos 34 membros tratados, 2,9% apresentaram hiperestesia, celulite e cordão fibroso, todos transitórios; em 8,8%, constatou-se hipoestesia perimaleolar, transitória e sem repercussão clínica; não houve relato de trombose venosa profunda. Das 34 safenas fotocoaguladas, houve 100% de oclusão imediata, uma recanalização sem refluxo no controle de um mês e 100% de oclusão após seis meses e um ano, mostrado pelo eco-Doppler. Conclusões Ablação utilizando endolaser 980 nm, ecoguiado em tempo real, sem intumescência perivenosa, promoveu fotocoagulação suficientemente controlada, com oclusão imediata e em médio prazo da VSM, de forma segura e eficaz, e configura-se como método terapêutico recomendável para o tratamento da doença venosa crônica.

Palavras-chave

varizes, insuficiência venosa, veia safena/cirurgia, terapia a laser

References

Proebstle TM, Moehler T, Gul D, Herdemann S. Endovenous treatment of the great saphenous vein using a 1,320 nm Nd:YAG laser causes fewer side effects than using a 940 nm diode laser. Dermatol Surg. 2005;31(12):1678-83.

Proebstle TM, Lehr HA, Kargl A. 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. 2002;35(4):729-36.

Bush RG. Regarding “Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombolytic occlusion after endoluminal thermal damage by laser-generated steam bubbles”. J Vasc Surg. 2003;37(1):242.

Kim HS, Nwankwo IJ, Hong K, McElgunn PS. Lower energy endovenous laser ablation of the great saphenous vein with 980 nm diode laser in continuous mode. Cardiovasc Intervent Radiol. 2006;29(1):64-9.

Palmieri B, Lapilli A, Benuzzi G. Endoluminal diode laser vein damage: preclinic study for vein insufficiency. Minerva Cardioangiol. 2003;51(1):95-9.

Proebstle TM, Sandhofer M, Kargl A. Thermal damage of the inner vein wall during endovenous laser treatment: key role of energy absorption by intravascular blood. Dermatol Surg. 2002;28(7):596-600.

Perkowski P, Ravi R, Gowda RC. Endovenous laser ablation of the saphenous vein for treatment of venous insufficiency and varicose veins: early results from a large single-center experience. J Endovasc Ther. 2004;11(2):132-8.

Campbell B. New treatments for varicose veins. BMJ. 2002;324(7339):689-90.

Lefebvre-Vilardebo M. The sapheno-femoral area: anatomic study and concepts for the prevention of varicose recurrences. J Mal Vasc. 1991;16(4):355-8.

Min RJ, Zimmet SE, Isaacs MN, Forrestal MD. Endovenous laser treatment of the incompetent greater saphenous vein. J Vasc Interv Radiol. 2001;12(10):1167-71.

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(2):117-22.

Goldman MP, Mauricio M, Rao J. Intravascular 1320-nm laser closure of the great saphenous vein: a 6- to 12-month follow-up study. Dermatol Surg. 2004;30(11):1380-5.

Hingorani AP, Ascher E, Markevich N. Deep venous thrombosis after radiofrequency ablation of greater saphenous vein: a word of caution. J Vasc Surg. 2004;40(3):500-4.

Proebstle TM, Krummenauer F, Gul D, Knop J. Nonocclusion and early reopening of the great saphenous vein after endovenous laser treatment is fluence dependent. Dermatol Surg. 2004;30(2 Pt 1):174-8.

Gloviczki P. Endovenous treatment of varicose veins: credentialing, quality control and education. Endovascular Today.. 2004;1(^sSuppl):28-9.

Maffei FHA. Diagnóstico clínico das doenças venosas periférica. Doenças vasculares periféricas. 2002:457-69.

Corcos L, Dini S, Anna D. The immediate effects of endovenous diode 808-nm laser in the greater saphenous vein: morphologic study and clinical implications. J Vasc Surg. 2005;41(6):1018-24, discussion 25.

Proebstle TM, Moehler T, Herdemann S. Reduced recanalization rates of the great saphenous vein after endovenous laser treatment with increased energy dosing: definition of a threshold for the endovenous fluence equivalent. J Vasc Surg. 2006;44(4):834-9.

Boné Salat C. Tratamiento endoluminal de las varices con láser de diodo: estudio preliminar. Rev Patol Vasc.. 1999;5:35-46.

Bush RG, Shamma HN, Hammond K. Histological changes occurring after endoluminal ablation with two diode lasers (940 and 1319 nm) from acute changes to 4 months. Lasers Surg Med. 2008;40(10):676-9.

Hoggan BL, Cameron AL, Maddern GJ. Systematic review of endovenous laser therapy versus surgery for the treatment of saphenous varicose veins. Ann Vasc Surg. 2009;23(2):277-87.

Leopardi D, Hoggan BL, Fitridge RA, Woodruff PW, Maddern GJ. Systematic review of treatments for varicose veins. Ann Vasc Surg. 2009;23(2):264-76.

Medeiros CAF. Comparação entre o laser endovenoso e a fleboextração total da veia safena interna: resultados em médio prazo. J Vasc Bras. 2006;5(4):277-87.

Viarengo LMA, Meirelles GV, Potério Filho J. Tratamento de varizes com laser endovenoso: estudo prospectivo com seguimento de 39 meses. J Vasc Bras. 2006;5(3):184-93.

Gérard JL, Desgranges P, Becquemin JP, Desse H, Melliere D. Feasibility of ambulatory endovenous laser for the treatment of greater saphenous varicose veins: one-month outcome in a series of 20 outpatients. J Mal Vasc. 2002;27(4):222-5.

Almeida J, Mackay E, Javier J, Mauriello J, Raines J. Saphenous laser ablation at 1470 nm targets the vein wall, not blood. Vasc Endovascular Surg. 2009;43(5):467-72.

Doganci S, Demirkilic U. Comparison of 980 nm laser and bare-tip fibre with 1470 nm and radial fibre in the treatment of great saphenous vein varicosities: a prospective randomised clinical trial. Eur J Vasc Endovasc Surg. 2010;40(2):254-9.

Vuylsteke ME, Thomis S, Mahieu P, Mordon S, Fourneau I. Endovenous laser ablation of the great saphenous vein using a bare fibre versus a tulip fibre: a randomized clinical trial. Eur J Vasc Endovasc Surg. 2012;44(6):587-92.

Corcos L, Dini S, Peruzzi G, Pontello D, Dini M, De Anna D. Duplex ultrasound changes in the great saphenous vein after endosaphenous laser occlusion with 808-nm wavelength. J Vasc Surg. 2008;48(5):1262-71.

Gaspar RJ, Simões MJ, Plapler H. Effects of the endolaser in the great saphenous vein to treat the chronic venous insufficiency. J Vasc Bras. 2011;10(1):81-2.

Carradice D, Mekako AI, Hatfield J, Chetter IC. Randomized clinical trial of concomitant or sequential phlebectomy after endovenous laser therapy for varicose veins. Br J Surg. 2009;96(4):369-75.

Theivacumar NS, Darwood RJ, Dellagrammaticas D, Mavor AI, Gough MJ. The clinical significance of below-knee great saphenous vein reflux following endovenous laser ablation of above-knee great saphenous vein. Phlebology. 2009;24(1):17-20.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddec55e0e8825a9227279a1 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections