Thomas M Proebstle1, Sylvia Herdemann. 1. Both authors are affiliated with the Department of Dermatology, University of Heidelberg, Heidelberg, Germany. thomas.proebstle@med.uni-heidelberg.de
Abstract
BACKGROUND: Dissection of incompetent perforator veins even when using the subfascial endoscopic perforator surgery technique is associated with substantial side effects. OBJECTIVE: The objective was to evaluate the feasibility of endovenous laser ablation of incompetent perforator veins. PATIENTS AND METHODS: A 940-nm diode laser and a Nd:YAG laser with 1,320 nm were used with laser fibers of 600 microm diameter. Perforators were accessed by ultrasound-guided puncture using 16- and 18-gauge cannulas, respectively. Fiber tips were placed below the fascia with at least 1-cm distance from the deep vein system. After administration of perivascular local anesthesia, laser energy was delivered in a pulsed fashion using laser power in the range between 5 and 30 W. RESULTS: A total of 67 perforators were treated. Except one vein, all others were occluded at Day 1 after treatment. With 1,320 nm at 10 W, a median of 250 J (range, 103-443 J) was delivered resulting in significantly reduced posttreatment diameters to a mean of 69+/-23% (p=.0005). With 940 nm at 30 W, a median of 290 J (range, 90-625 J) was administered, showing no significant posttreatment diameter reduction. Side effects were moderate. CONCLUSION: Ultrasound-guided endovenous ablation of incompetent perforators is safe and feasible.
BACKGROUND: Dissection of incompetent perforator veins even when using the subfascial endoscopic perforator surgery technique is associated with substantial side effects. OBJECTIVE: The objective was to evaluate the feasibility of endovenous laser ablation of incompetent perforator veins. PATIENTS AND METHODS: A 940-nm diode laser and a Nd:YAG laser with 1,320 nm were used with laser fibers of 600 microm diameter. Perforators were accessed by ultrasound-guided puncture using 16- and 18-gauge cannulas, respectively. Fiber tips were placed below the fascia with at least 1-cm distance from the deep vein system. After administration of perivascular local anesthesia, laser energy was delivered in a pulsed fashion using laser power in the range between 5 and 30 W. RESULTS: A total of 67 perforators were treated. Except one vein, all others were occluded at Day 1 after treatment. With 1,320 nm at 10 W, a median of 250 J (range, 103-443 J) was delivered resulting in significantly reduced posttreatment diameters to a mean of 69+/-23% (p=.0005). With 940 nm at 30 W, a median of 290 J (range, 90-625 J) was administered, showing no significant posttreatment diameter reduction. Side effects were moderate. CONCLUSION: Ultrasound-guided endovenous ablation of incompetent perforators is safe and feasible.
Authors: Misaki M Kiguchi; Eric S Hager; Daniel G Winger; Stanley A Hirsch; Rabih A Chaer; Ellen D Dillavou Journal: J Vasc Surg Date: 2014-01-06 Impact factor: 4.268