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A Journal on Phlebology
Acta Phlebologica 2006 April;7(1):13-21
Endovenous laser photo-coagulation: histological and duplex findings; clinical implications
Corcos L. 1, De Anna D. 1, Dini S. 2, Spina T. 3, Peruzzi G. 3, Ferlaino E. 3, Pontello D. 1, Marangoni O. 4, Dini M. 5
1 Scuola di Specializzazione in Chirurgia Vascolare Università degli Studi di Udine, Udine
2 Dipartimento di Patologia Umana e Oncologia Università degli Studi di Firenze, Firenze
3 Laboratorio Vascolare, Istituto Prosperius di Firenze, Firenze
4 Centro Multilaser, Trieste
5 Dipartimento di Chirurgia Plastica Università degli Studi di Firenze, Firenze
Aim. Valuable demonstrations of the mechanism of action of incompetent greater saphenous veins (VGS) endovenous laser (LEV) were not produced. Aim of the study is to evaluate VGS morphologic alterations by the LEV, follow up their development up to 12 months and describe the clinical implications.
Methods. Studies: 1st histological of 35 VGS fragments up to 2 months; 2nd by duplex examination up to 12 months (total 79) of 44 VGS of 64 limbs subjected to saphenofemoral interruption (ISF)+LEV by a diode laser 808 nm. (Eufoton-Trieste-Italia), sterilyzable fibres, continuous emission 8-12 Watts,> 30 J/cm <, pull-back speed1-3mm/sec, down to the superior third of the leg.
Results. Histology: early: intimal damage in 29/29, average penetration of 194.40 micron (14.61% of the mean wall thickness); optimal results <10 mm; at 30-60 days: venous wall hypotrophy, thrombi with peripheral fibrosis and necrotic inclusions. Duplex: Thrombi: fresh at 7 days 100%, mixed at 1 month 52%, at 2 months 54%, fibrous at 6 months 75%, VGS scleroatrophy at 12 months 77%, 15,9% nonoccluded segments, 11,3% recanalyzed, 2 recurrences (4,5%).
Conclusions. LEV by the described technique leads to partial and sufficient vein wall injury to assure venous occlusion with optimal results <10 mm. Thrombi LEV induced are different from the spontaneous ones for