View
4
Download
0
Category
Preview:
Citation preview
Laser technologies for endovenous ablations:
What are the latest developments
Matthias Ulrich, MD Division for Interventional Angiology University-Hospital Leipzig, Germany
Laser Ablation Technique - Endovenous laser treatment for varicose
veins using an optical fiber inserted into the vein
- great saphenous vein - small saphenous vein - sidebranches - using LASER light – infrared portion of
the spectrum
Procedure / Steps
Percutaneous duplex ultrasound guided access to the distal - great saphenous
vein or - small saphenous
vein
Procedure / Steps - GSV entered at the knee or SSV mid portion of calf
- guide wire passed through the needle into the vein
- remove the needle and insert Introducer sheath over a
guide wire
- removal of the guidewire and insertion of the Laser
fiber
- placement of the fiber tip 0-2 cm distal to saphenous
vein junction
- Tumescent anesthesia
CFV
GSV
Laserfiber tip
Wavelength and Fiber
- 1998 first try λ 980 nm and 810 nm barefiber
- 2005 λ 1470 nm bare fiber
- 2008 λ 1470 nm radial fiber - 2010 λ 1470 nm radial slim fiber
Wavelength and Fiber
λ 980 nm and 810 nm λ 1470 nm
bare fiber
Wavelength and Fiber
radial fiber 360°
Radial emitting ! Homogenous laser fiber
circumferential 360° energy emission
Advantage of radial fiber
Energy delivery during Pull Back (1470nm,10 watt 70-80J/cm)
Endovenous laser ablation of great and small saphenous vein incompetence
with a 1470-nm laser and radial fiber
Giorgio Spreafico, MD, Andrea Piccioli, MD, Enrico Bernardi, MD,PhD, Enzo Giraldi, MD,Patrizia Pavei, MD,
Riccardo Borgoni, Professor of Statistics, Attilio Nosadini, MD, and Ugo Baccaglini Professor of Surgery at Padua,
Pieve di Soligo, and Milan, Italy
J Vasc Surg: Venous and Lym Dis 2014;-:1-8.
Study Design
- Prospective cohort study - Patients recruited between May 2008 and
December 2011 - 381 consecutive patients (317 GSV and 62
SSV) - 372 patients completed 12-month follow-up
Results
- 100% occlusion rate (GSV and SSV) mean 22 months follow up (min 12 max 48 months)
- Amount of the energy delivered targeted to the diameter of the saphenous trunk
- Laser in continuous mode, with a power of 5 to 6 W
- 2/3 of the patients had no pain - More than 2/3 of the patients didn‘t use
any pain killer - Pain is often referred to the site of
phlebectomies
Secondary outcome: post-operative pain
New Devices
- Slim Fiber 2 rings BioLitec (Leonardo mini)
4 French = 1,3 mm = 400 µm
SCLEROLUX®
New Devices
Zhang Q, Huang SM, Meng LY, Wang XD, Ding JQ.
Endovenous holmium laser treatment for varicose veins
Zhonghua Wai Ke Za Zhi. 2004 Oct 22;42(20):1244-6)
New Devices
Not Clots
New Devices
Pow
er [W
]
CW Chopped (PW) PW
Tem
pera
ture
[°C
]
EVLA: MECHANISM OF ACTION λ 2,100 nm laser
Short Pulse : 350 µs
First step Short Pulse
Ho:YAG LASER SHRINKAGE
TUNICA MEDIA
67°C fraction of seconds
" 550 mm optical fiber (17 G needle)
" CALIBER VEIN REDUCTION
" LESS BLOOD VOLUME
" NO INTIMAL INJURY
" NO DAMAGE TO THE ADVENTITIA
" NO INTUMESCENT SOLUTION IS REQUIRED
NO RISK OF
NERVE INJURY
Patient feed-back
Second step
– re-insertion of sheath / delivery catheter – pullback and
foamsclerotherapy with Aethoxysklerol
New Devices
- Office procedure (no hospitalization)
- Less energy than conventional EVLA
- Less energy leads to less side effects
- No tumescent solution needed
proVENE ®
EVLA by ENDOTEQ
New Devices
ETQ 360° FUSED Fiber
neoV 1470 - neoV1470 surgical laser – actual the smallest, laser system of its power class.
- Laser interaction with tissue depends on the wavelength of 1470 nm diode laser - wavelength is highly absorbed by water in tissue. - heat generation is highly localized in the vein wall
proVENE 360° FUSED Fiber
- 360° radiation - 600µm or 400µm fiber - tment of Vena saphena
magna and Vena saphena parva as well as for perforaor veins
- manufactured with FUSION technology
Benefit for patients
Almost free of complications
Homogenous photothermal destruction of the vein wall
safety with pilotbeam
Individual therapy for different types of veins
Thank you
Recommended