Top

Published in:

12-07-2022 | Varicosis | Original Article

Endovenous laser ablation using laser systems emitting at wavelengths > 1900 nm: a systematic review

Authors: Abhay Setia, Claus-Georg Schmedt, Ronald Sroka

Published in: Lasers in Medical Science | Issue 9/2022

Abstract

The aim of this systematic review was to summarize the currently available literature reporting clinical application of endovenous laser ablation (EVLA) by means of laser systems emitting at wavelengths > 1900 nm, pertaining dosimetry, intraoperative parameters, postoperative outcomes, and efficacy based on occlusion rates, recanalization, and postoperative complications. A literature search was conducted in PubMed, Cochrane Library, Embase, OVID, and Web of Science for publications since the year 2000 until December 2021. Case series, prospective trials, retrospective studies, and randomized controlled trials describing the application of a 1920/1940-nm wavelength laser for EVLA in humans with a minimum of one postoperative follow-up visit were included in the study. Four case series and one randomized controlled trial with a total of 509 EVLA procedures (396 great saphenous veins and 113 small saphenous veins) were identified, meeting the inclusion criteria. The studies were heterogenous in their documentation, EVLA, and duplex ultrasound protocol and result reporting. Overall, the applied average cumulative LEED values ranged from 17.8 to 53 J/cm. Complications observed were pigmentation (0–9.75%), paresthesia (2.5–7.3%), thrombophlebitis (0–5%), EHIT Class 2 (2.26–2.4%), and EHIT Class 1 (1.2–2.4%). Four cases of recanalizations were observed in one study cohort within the first month after treatment. Follow-up at 12 months was available for 3 studies (procedures n = 218) with recanalizations in 8 limbs. Follow-up at 24–36 months was available for 2 studies (procedures n = 126) showing recanalizations in 5 limbs. Recanalizations were asymptomatic and incidental findings on follow-up duplex ultrasound. Pooled occlusion rates were 99.2% at 1 M, 96.3% at 12 M, and 96% at 24 M. Overall, patients undergoing EVLA with long wavelength laser systems > 1900 nm show high occlusion rates, significant improvement in VCSS, low postoperative complication rate, low pain levels, low analgesic requirement, and early convalescence. Apart from persistent paresthesia, all the complications regressed spontaneously within 6 months. EVLA by means of 1920/1940 nm shows promising clinical results with high efficacy and low complication rates. Heterogeneity still exists regarding ideal protocol for duplex ultrasound examination and documentation of anatomical parameters (e.g., vein diameter, ideal stump length and status of accessory veins) and light dosimetry for EVLA.

Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML et al (2011 May) (2011) The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 53(5 Suppl):2S-48S. https://doi.org/10.1016/j.jvs.2011.01.079

(National Clinical Guideline Centre (UK) (2013) Varicose veins in the legs: the Diagnosis and management of varicose veins. National Institute for Health and Care Excellence (NICE), London

Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S et al (2015) Editor’s Choice - Management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 49(6):678–737CrossRefPubMed

De Maeseneer et al. European Society for Vascular Surgery (ESVS) 2022 Clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg:S1078-5884(21)00979-5. https://doi.org/10.1016/j.ejvs.2021.12.024

Pannier F, Noppeney T, Alm J, Breu FX, Bruning G, Flessenkämper I et al (2019) S2k- Leitlinie Diagnostik und Therapie der Varikose. AWMF Online 03/2019. https://www.awmf.org/uploads/tx_szleitlinien/037-018l_S2k_Varikose_Diagnostik-Therapie_2019-07.pdf

Vuylsteke M, De Bo TH, Dompe G, Di Crisci D, Abbad C, Mordon S (2011) Endovenous laser treatment: is there a clinical difference between using a 1500 nm and a 980 nm diode laser? A multicenter randomised clinical trial. Int Angiol 30(4):327–334PubMed

Jibiki M, Miyata T, Futatsugi S, Iso M, Sakanushi Y (2016) Effect of the wide-spread use of endovenous laser ablation on the treatment of varicose veins in Japan: a large-scale, single institute study. Laser Ther 25(3):171–177CrossRefPubMedPubMedCentral

Lawson JA, Gauw SA, van Vlijmen C et al (2018) Prospective comparative cohort study evaluating incompetent great saphenous vein closure using radiofrequency-powered segmental ablation or 1470-nm endovenous laser ablation with radial-tip fibers (Varico 2 study). J Vasc Surg Venous Lymphat Disord 6(1):31–40CrossRefPubMed

Pavei P, Spreafico G, Bernardi E, Giraldi E, Ferrini M (2021) Favorable long-term results of endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber. J Vasc Surg Venous Lymphat Disord 9(2):352–360. https://doi.org/10.1016/j.jvsv.2020.06.015CrossRefPubMed

10.

Sroka R, Weick K, Sadeghi-Azandaryani M, Steckmeier B, Schmedt C-G (2010) Endovenous laser therapy – application studies and latest investigations. J Biophoton 3:269–276CrossRef

11.

Sroka R, Pongratz T, Siegrist K, Burgmeier C, Barth HD, Schmedt CG (2013) Endovenous laser application strategies to improve endoluminal energy application. Phlebology 42:121–123CrossRef

12.

Schmedt C, Esipova A, Dikic S, Demhasaj S, Comsa F, Sroka R (2014) Erste klinische Ergebnisse der Endovenösen Lasertherapie (ELT) mit Thulium (Tm) Laser (1940nm) und radialer Lichtapplikation. Vasomed 26:294

13.

Proebstle TM, Moehler T, Gül D, Herdemann S (2005) 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 31(12):1678–1684PubMed

14.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71CrossRefPubMedPubMedCentral

15.

Kabnick LS et al (2021) Classification and treatment of endothermal heat-induced thrombosis: recommendations from the American Venous Forum and the Society for Vascular Surgery. J Vasc Surg Venous Lymphat Disord 9(1):6–22. https://doi.org/10.1016/j.jvsv.2020.06.008CrossRefPubMed

16.

Meissner MH, Natiello C, Nicholls SC (2002) Performance characteristics of the venous clinical severity score. J Vasc Surg 36:889–895CrossRefPubMed

17.

Mendes-Pinto D, Bastianetto P, Cavalcanti Braga Lyra L, Kikuchi R, Kabnick L (2016) Endovenous laser ablation of the great saphenous vein comparing 1920-nm and 1470-nm diode laser. Int Angiol 35(6):599–604PubMed

18.

Viarengo LMA, Viarengo G, Martins AM, Mancini MW, Lopes LA (2017) Resultados de médio e longo prazo do tratamento endovenoso de varizes com laser de diodo em 1940 nm: análise crítica e considerações técnicas. J Vasc Bras 16(1):23–30CrossRefPubMedPubMedCentral

19.

Park I (2019) Initial outcomes of endovenous laser ablation with 1940 nm diode laser in the treatment of incompetent saphenous veins. Vascular 27(1):27–32CrossRefPubMed

20.

Park I, Park SC (2020) Comparison of short-term outcomes between endovenous 1,940-nm laser ablation and radiofrequency ablation for incompetent saphenous veins. Front Surg 7:620034CrossRefPubMedPubMedCentral

21.

Setia A, Schmedt CG, Beisswenger A, Dikic S, Demhasaj S, Setia O, Schmitz-Rixen T, Sroka R (2022 Apr) Safety and efficacy of endovenous laser ablation (EVLA) using 1940 nm and radial emitting fiber: 3-year results of a prospective, non-randomized study and comparison with 1470 nm. Lasers Surg Med 54(4):511–522. https://doi.org/10.1002/lsm.23500

22.

Artemov SA et al (2021) Morphological changes of veins and perivenous tissues during endovenous laser coagulation using 2-μm laser radiation and various types of optical fibers. J Vasc Surg Venous Lymphat Disord S2213–333X(21)00428–5. https://doi.org/10.1016/j.jvsv.2021.08.018

23.

Artemov SA et al (2020) Optimization of the endovenous laser coagulation using two-micron laser radiation. 2020 International Conference Laser Optics (ICLO), pp 1–1. https://doi.org/10.1109/ICLO48556.2020.9285909

24.

Somunyudan MF, Topaloğlu N, Ergenoğlu MÜ, Gülsoy M (2010) Endovenous laser ablation (EVLA) with Tm-fiber laser. 2010 15th National Biomedical Engineering Meeting, pp 1–3. https://doi.org/10.1109/BIYOMUT.2010.5479797

25.

de Araujo WJB, Timi JRR, Kotze LR, Vieira da Costa CR (2019) Comparison of the effects of endovenous laser ablation at 1470 nm versus 1940 nm and different energy densities. Phlebology 34(3):162–170. https://doi.org/10.1177/0268355518778488CrossRefPubMed

26.

Whiteley MS, Cross AC, Whiteley VC (2021) No significant difference between 1940 and 1470 nm in endovenous laser ablation using an in vitro porcine liver model. Lasers Med Sci. https://doi.org/10.1007/s10103-021-03449-0CrossRefPubMed

27.

Minaev VP, Minaev NV, Bogachev VY et al (2021) Endovenous laser coagulation: asymmetrical heat transfer (modeling in water). Lasers Med Sci 36:1599–1608. https://doi.org/10.1007/s10103-020-03184-yCrossRefPubMed

28.

Konstantin AK et al (2020) The 1940 nm, laser, are there any advantages?. Eur J Vasc Endovasc Surg 60(4):e73-e74.ISSN 1078–5884. https://doi.org/10.1016/j.ejvs.2020.07.056.

29.

Staniszewska, Tambyraja A, Afolabi E, Bachoo P, Brittenden J (2013) The Aberdeen Varicose Vein Questionnaire, patient factors and referral for treatment. Eur J Vasc Endovasc Surg 46(6):715–718. ISSN 1078–5884. https://doi.org/10.1016/j.ejvs.2013.08.019

30.

Goldman MP, Mauricio M, Rao J (2004) Intravascular 1320-nm laser closure of the great saphenous vein: a 6- to 12-month follow-up study. Dermatol Surg 30(11):1380–1385PubMed

31.

Proebstle TM, Moehler T, Gül D, Herdemann S (2005) Endovenous treatment of the great saphenous vein using a 1320 nm Nd:YAG laser causes fewer side effects than using a 940 nm diode laser. Dermatol Surg 31(12):1678–1683PubMed

32.

Mordon SR, Wassmer B, Zemmouri J (2006) Mathematical modeling of endovenous laser treatment (ELT). BioMed Eng OnLine 5:26. https://doi.org/10.1186/1475-925X-5-26CrossRefPubMedPubMedCentral

33.

Medical Advisory Secretariat (2010) Endovascular laser therapy for varicose veins: an evidence-based analysis. Ont Health Technol Assess Ser 10(6):1–92PubMedCentral

34.

Sroka R, Weick K, Steckmaier S, Steckmaier B, Blagova R, Sroka I, Sadeghi-Azandaryani M, Maier J, Schmedt CG (2012) The ox-foot-model for investigating endoluminal thermal treatment modalities of varicosis vein diseases. ALTEX-Altern Anim Exp 29(4):403–410

35.

Yamamoto T, Sakata M (2014) Influence of fibers and wavelengths on the mechanism of action of endovenous laser ablation. J Vasc Surg Venous Lymphat Disord 2:61–69CrossRefPubMed

36.

Schwarz T, von Hodenberg E, Furtwängler C, Rastan A, Zeller T, Neumann FJ (2010) Endovenous laser ablation of varicose veins with the 1470-nm diode laser. J Vasc Surg 51(6):1474–1478. https://doi.org/10.1016/j.jvs.2010.01.027CrossRefPubMed

37.

Pannier F, Rabe E, Rits J, Kadiss A, Maurins U (2011) Endovenous laser ablation of great saphenous veins using a 1470 nm diode laser and the radial fiber – follow-up after six months. Phlebology 26(1):35–39CrossRefPubMed

38.

Doganci S, Demirkilic U (2010) Comparison of 980nm laser and bare-tip fiber with 1470nm laser and radial fiber in the treatment of great saphenous vein varicosities: a prospective randomized clinical trial. Eur J Vasc Endovasc Surg 40(2):254–259CrossRefPubMed

39.

Hirokawa M, Ogawa T, Sugawara H, Shokoku S, Sato S (2015) Comparison of 1470 nm laser and radial 2ring fiber with 980 nm laser and bare-tip fiber in endovenous laser ablation of saphenous varicose veins: a multicenter, prospective, randomized, non-blind study. Ann Vasc Dis 8(4):282–289. https://doi.org/10.3400/avd.oa.15-00084CrossRefPubMedPubMedCentral

40.

Kuestner JT, Norris KH (1994) Spectrophometry of human hemoglobin in the near infrared region from 1000 to 2500nm. J Near Infrared Spectrosc 2:59CrossRef

41.

Spinedi L, Stricker H, Keo HH, Staub D, Uthoff H (2020) Feasibility and safety of flush endovenous laser ablation of the great saphenous vein up to the saphenofemoral junction. J Vasc Surg Venous Lymphat Disord 8:1006e13

42.

Winokur RS, Khilnani NM, Min RJ (2016) Recurrence patterns after endovenous laser treatment of saphenous vein reflux. Phlebology 31:496e500CrossRef

43.

Malskat WSJ, Engels LK, Hollestein LM, Nijsten T, van den Bos RR (2019) Commonly used endovenous laser ablation (EVLA) parameters do not influence efficacy: results of a systematic review and meta-analysis. Eur J Vasc Endovasc Surg 58:230e42CrossRef

44.

Whiteley MS (2019) If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck. What “the duck test” tells us about systematic reviews and meta-analyses of LEED and other EVLA parameters. Eur J Vasc Endovasc Surg 58(2):243. https://doi.org/10.1016/j.ejvs.2019.04.023CrossRefPubMed

45.

Healy DA, Kimura S, Power D, Elhaj A, Abdeldaim Y, Cross KS et al (2018) A systematic review and meta-analysis of thrombotic events following endovenous thermal ablation of the great saphenous vein. Eur J Vasc Endovasc Surg 56:410e24CrossRef

46.

Mühlberger D, Morandini L, Brenner E (2009) Venous valves and major superficial tributary veins near the saphenofemoral junction. J Vasc Surg 49(6):1562–1569. https://doi.org/10.1016/j.jvs.2009.02.241CrossRefPubMed

47.

Pannier F, Rabe E, Maurins U (2009) First results with a new 1470-nm diode laser for endovenous ablation of incompetent saphenous veins. Phlebology 24(1):26–30. https://doi.org/10.1258/phleb.2008.008038CrossRefPubMed

Title: Endovenous laser ablation using laser systems emitting at wavelengths > 1900 nm: a systematic review
Authors: Abhay Setia
Claus-Georg Schmedt
Ronald Sroka
Publication date: 12-07-2022
Publisher: Springer London
Keywords: Varicosis
Varicosis
Varicosis
Laser
Published in: Lasers in Medical Science / Issue 9/2022
Print ISSN: 0268-8921
Electronic ISSN: 1435-604X
DOI: https://doi.org/10.1007/s10103-022-03609-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endovenous laser ablation using laser systems emitting at wavelengths > 1900 nm: a systematic review

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 9/2022

Advanced methylene blue — nanoemulsions for in vitro photodynamic therapy on oral and cervical human carcinoma

Excimer light therapy with systemic corticosteroids improved severe chronic nodular prurigo and altered peripheral nerve fibers in the epidermis

The effectiveness of antimicrobial photodynamic therapy with prodigiosin against reference strains of Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa

Laser- and intense pulsed light (IPL)-induced vitiligo patches: a systematic review of the literature — short report

A novel 1726-nm laser system for safe and effective treatment of acne vulgaris

Structural changes in subcutaneous and visceral abdominal fatty tissue induced by local application of 448 kHz capacitive resistive monopolar radiofrequency: a magnetic resonance imaging case study