Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202201461
Jornal Vascular Brasileiro
Innovation

Descrição da técnica LEST: laser endovenoso de safena e tributárias

Endovenous laser ablation for saphenous veins and tributaries - the LEST technique

Adriano Carvalho Guimaraes; Ricardo Herkenhoff Moreira; Petra Cristina Van Den Bogert; Sergio Quilici Belczak; Felipe Coelho Neto; Walter Jr. Boim de Araujo

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Resumo

Atualmente, a ablação térmica endovenosa é uma das principais técnicas para o tratamento da insuficiência venosa crônica. Com o refinamento técnico e as inovações tecnológicas, é possível aplicá-la, além de em veias safenas, em veias superficiais como as tributárias varicosas. Descrevemos uma técnica de tratamento cirúrgico de varizes por termoablação com laser endovenoso empregando-se múltiplas punções e a experiência do serviço após a análise de 601 casos operados com a técnica. O tratamento termoablativo de veias tributárias com múltiplos sítios de punção expande a aplicação do uso do endolaser no tratamento das varizes de membros inferiores de forma adequada, visando, assim, a um tratamento amplo, seguro e eficaz.

Palavras-chave

varizes; termoablação; insuficiência venosa

Abstract

Endovenous thermal ablation is now one of the most important techniques for treating chronic venous insufficiency. Technical refinements and technological innovations have made it possible to employ the method not only in the saphenous veins, but also to treat superficial veins such as varicose tributaries. We describe a technique for surgical treatment of varicose veins using endovenous laser thermal ablation employing multiple punctures and present the experience at our service with analysis of 601 cases operated using this technique. Thermoablative treatment of tributary veins with multiple puncture sites expands the applications for endolaser in treatment of lower limb varicose veins, providing, comprehensive, safe, and effective treatment.

Keywords

varicose veins; thermoablation; venous insufficiency

References

1 Coon WW, Willis PW 3rd, Keller JB. Venous thromboembolism and other venous disease in the Tecumseh community health study. Circulation. 1973;48(4):839-46. http://doi.org/10.1161/01.CIR.48.4.839. PMid:4744789.

2 Matic M, Matic A, Djuran V, Gajinov Z, Prcic S, Golusin Z. Frequency of peripheral arterial disease in patients with chronic venous insufficiency. Iran Red Crescent Med J. 2016;18(1):e20781. http://doi.org/10.5812/ircmj.20781. PMid:26889387.

3 Campbell WB, Vijay Kumar A, Collin TW, Allington KL, Michaels JA, Randomised and Economic Analysis of Conservative and Therapeutic Interventions for Varicose veins Study. The outcome of varicose vein surgery at 10 years: clinical findings, symptoms and patient satisfaction. Ann R Coll Surg Engl. 2003;85(1):52-7. http://doi.org/10.1308/003588403321001462. PMid:12585635.

4 Ostler AE, Holdstock JM, Harrison CC, Price BA, Whiteley MS. Strip-tract revascularization as a source of recurrent venous reflux following high saphenous tie and stripping: results at 5-8 years after surgery. Phlebology. 2015;30(8):569-72. http://doi.org/10.1177/0268355514535927. PMid:24844250.

5 Nyamekye I, Shephard NA, Davies B, Heather BP, Earnshaw JJ. Clinicopathological evidence that neovascularisation is a cause of recurrent varicose veins. Eur J Vasc Endovasc Surg. 1998;15(5):412-5. http://doi.org/10.1016/S1078-5884(98)80202-5. PMid:9633496.

6 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. PMid:11207682.

7 Kim HK, Kim HJ, Shim JH, Baek MJ, Sohn YS, Choi YH. Endovenous lasering versus ambulatory phlebectomy of varicose tributaries in conjunction with endovenous laser treatment of the great or small saphenous vein. Ann Vasc Surg. 2009;23(2):207-11. http://doi.org/10.1016/j.avsg.2008.05.014. PMid:18684588.

8 Sam RC, Silverman SH, Bradbury AW. Nerve injuries and varicose vein surgery. Eur J Vasc Endovasc Surg. 2004;27(2):113-20. http://doi.org/10.1016/j.ejvs.2003.11.007. PMid:14718891.

9 de Araujo WJB, Guimarães AC, Moreira RH. Fístula arteriovenosa após termoablação com laser endovenoso 1470 nm: relato de caso. J Vasc Bras. 2016;15(3):254-8. http://doi.org/10.1590/1677-5449.003516. PMid:29930599.

10 Amatuzi D, Drummond DAB, Poschinger-Figueiredo D, Barbosa-Silva L, Oliveira JCP, Marques MA. Ablação térmica total assistida: apresentação da técnica ATTA. J Vasc Bras. 2022;21:e20220048. http://doi.org/10.1590/1677-5449.202200482. PMid:36452404.

11 Ferreira MB, Galego GDN, Nazário NO, et al. Use of 1,470 nm laser for treatment of superficial venous insufficiency. J Vasc Bras. 2021;20:e20200244. http://doi.org/10.1590/1677-5449.200244. PMid:34290757.

12 Dabbs EB, Mainsiouw LE, Holdstock JM, Price BA, Whiteley MS. A description of the ‘smile sign’ and multi-pass technique for endovenous laser ablation of large diameter great saphenous veins. Phlebology. 2018;33(8):534-9. http://doi.org/10.1177/0268355517734480. PMid:28956693.

13 Starodubtsev V, Lukyanenko M, Karpenko A, Ignatenko P. Endovenous laser ablation in patients with wide diameter of the proximal segment of the great saphenous vein: Comparison of methods. Phlebology. 2015;30(10):700-5. http://doi.org/10.1177/0268355514555546. PMid:25305462.

14 Müller L, Alm J. Feasibility and technique of endovenous laser ablation (EVLA) of recurrent varicose veins deriving from the sapheno-femoral junction-A case series of 35 consecutive procedures. PLoS One. 2020;15(7):e0235656. http://doi.org/10.1371/journal.pone.0235656. PMid:32628724.

15 Price BA, Harrison CC, Holdstock JM. Thermoablation using the hedgehog technique for complex recurrent venous reflux patterns. J Vasc Surg Cases Innov Tech. 2016;2(4):181-3. http://doi.org/10.1016/j.jvscit.2016.07.005.

16 Nakashima M, Kobayashi M. Endovenous laser ablation combined with stripping technique for large saphenous varicose veins: the selection of operation technique. Ann Vasc Dis. 2019;12(4):514-8. http://doi.org/10.3400/avd.oa.18-00169. PMid:31942210.

17 Zerweck C, von Hodenberg E, Knittel M, Zeller T, Schwarz T. Endovenous laser ablation of varicose perforating veins with the 1470-nm diode laser using the radial fibre slim. Phlebology. 2014;29(1):30-6. http://doi.org/10.1258/phleb.2012.012072. PMid:23155134.

18 Myers KA, Clough A, Tilli H. Endovenous laser ablation for major varicose tributaries. Phlebology. 2013;28(4):180-3. http://doi.org/10.1258/phleb.2011.011088. PMid:22490724.
 


Submitted date:
09/02/2023

Accepted date:
05/05/2024

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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