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Acta Phlebologica 2017 August;18(2):41-6

DOI: 10.23736/S1593-232X.17.00399-X


language: English

Endovenous ablation of saphenous veins with 1470-nm laser without tumescence

Julio H. FERREIRA 1 , Luciano C. ALBUQUERQUE 2, Luciare G. BARRENECHE 2, Marco A. GOLDANI 2, Antonio C. REICHELT 1

1 Unit of Phlebology, Department of Cardiovascular Surgery, São Lucas Hospital, PUCRS, Porto Alegre, Brazil; 2 Department of Cardiovascular Surgery, São Lucas Hospital, PUCRS, Porto Alegre, Brazil


BACKGROUND: Traditional protocols for saphenous veins ablation with laser state that the procedure should be performed under tumescent local anesthesia (TLA) which is designed to achieve 3 objectives: 1) to intimate contact between the vein wall and the optical fiber; 2) to create a termal buffer to avoid damage to neighbouring tissues; and obviously 3) to provide anesthesia but despite these positive effects, the large amount of liquid injected around the vein makes it difficult to observe the ablation process in real time with ultrasound, with the result that the surgeon is uncertain whether the vein has truly been closed by the ablation process or has simply been compressed extrinsically. Other issues of TLA are that some adverse effects were identified such as hipersensitivity, CNS, and cardiovascular reactions, methaemoglobin formation and fluid overload. The purpose of ovoiding tumescent anesthesia (TA) is to be able to adjust laser energy delivery in real time during the procedure based on ultrasound information, a technique that is not feasible when TLA is used. This study analyses occlusion and complication rates in a series of patients treated without tumescence.
METHODS: A sample of 885 patients treated at the San Lucas da PUCRS Hospital from January 2009 to December 2012 was selected. In this group, a total of 1077 saphenous veins were treated using systemic analgesia, a 1470-nm 15 watts diode laser source (Ceralas E/1470 Biolitec®, Milan, Italy), radial emission fibers (Ceramoptec Gmbh®, Bonn, Germany), and constant ultrasonographic control throughout all the ablation procedure. Energy dosage was defined using ultrasound criteria. Patients were assessed 7, 30, 90, 180, and 360 days after the procedure.
RESULTS: Complete closure was achieved in 100% of the patients and persisted at 1-year follow-up. Superficial phlebitis occurred in 3 cases (0.3%), hyperpigmentation in 2 (0.2%), and infection of the puncture site in 1 patient (0.1%).
CONCLUSIONS: In this study, endovenous laser therapy of saphenous veins using a 1470-nm radial-fiber laser, without tumescent anesthesia, is an effective and safe procedure. The rate of complete closure was 100% after 365 days.

KEY WORDS: Varicose veins - Saphenous vein - Lasers

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