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