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Endovenous Laser Therapy for Lower Limb Varicose Veins: intermediate outcomes of 800 limbs . PowerPoint PPT Presentation


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Endovenous Laser Therapy for Lower Limb Varicose Veins: intermediate outcomes of 800 limbs . Khalid AL- Ghamdi , MD Vascular Fellow , King Saud University King Khalid University Hospital . Riyadh, Saudi Arabia. Endovenous Laser Therapy for Lower Limb Varicose Veins.

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Endovenous Laser Therapy for Lower Limb Varicose Veins: intermediate outcomes of 800 limbs .

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Endovenous laser therapy for lower limb varicose veins intermediate outcomes of 800 limbs

Endovenous Laser Therapy for Lower Limb Varicose Veins: intermediate outcomes of 800 limbs

.

Khalid AL-Ghamdi, MD

Vascular Fellow , King Saud University

King Khalid University Hospital

. Riyadh,

Saudi Arabia


Endovenous laser therapy for lower limb varicose veins

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Therapeutic Options for truncal varicose veins

Open procedures:

High ligation :

Barrier techniques.

Stripping :

Invagination.

Cryostripping.

Electrical stripping.

Endoscopic stripping.


Endovenous laser therapy for lower limb varicose veins1

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Therapeutic Options for truncal varicose veins

Endovenous procedures:

Endothermal obliteration:

- Radiofrequency ablation (RFA)

VNUS Closure plus & fast.

Celon RFITT

- Laser Therapy (ELT)

810 – 1470 nm

Bare fiber

Cylindrical diffuser

Radial fiber


Endovenous laser therapy for lower limb varicose veins2

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Therapeutic Options for truncal varicose veins

Endovenous procedures:

Chemical obliteration:

Ultra-sound Guided Foam Sclerotherapy.


Endovenous laser therapy for lower limb varicose veins3

Endovenous Laser Therapy for Lower Limb Varicose Veins.

First Publication of Endovenous Laser

Endovenous Laser : a new minimally invasive method of treatment for varicose veins – preliminary observation using an 810 nm diode laser.

Navarro L et al Dermato Surg 2001:27(2):117-22.

Vein treatment Center & Beth Israel Medical Center.NY,USA.


Endovenous laser therapy for lower limb varicose veins4

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Interventions for varicose veins

Millennium Research Group – Market Growth in Varicose Veins Procedures (USA)


Endovenous laser therapy for lower limb varicose veins5

VEIN WALL

HEATING

FIBER

LASER BEAM

CATHETER

HEATING

BLOOD

HEATING

Endovenous Laser Therapy for Lower Limb Varicose Veins.

irreversible localized

venous tissue damage

INTERACTION GEOMETRY

How EVLT Work


Endovenous laser therapy for lower limb varicose veins6

  • 10 C – 45 C:Conformation change of proteins

  • 50 C:Reduction of enzyme activity

  • 60 C: Denaturation

  • 100 C: Water vaporizes

  • Thermal damage

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Tissue Ablation


Endovenous laser therapy for lower limb varicose veins7

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Endolaser

Available Wave Lengths:

810 nm - Dropped.

940 nm.

980 nm.

New 1320.

New 1470 - The best so far.


Endovenous laser therapy for lower limb varicose veins8

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Endolaser

Advantages:

Efficient : more than 95%.

Adapt energy according size of the vein.

Adapt energy according depth of the vein.

Less painful & less ecchymosis with 1470nm.


Endovenous laser therapy for lower limb varicose veins9

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Objectives

Early & Intermediate

Outcomes of EVLT in patients with varicose veins.


Endovenous laser therapy for lower limb varicose veins10

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Study Design

Prospective Non – Randomized Clinical Trial

Setting

Vascular Surgery Division - KKUH

Methods

Period

March 1,2006 – february 28, 2013


Endovenous laser therapy for lower limb varicose veins11

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Inclusion Criteria

Patients with incompetent GSV & SSV

Intervention

EVLT using 980-nm and 1470-nm laser

tumescent local anaesthetics

Methods

Follow - up

Venous Duplex at 1week and 6months


Endovenous laser therapy for lower limb varicose veins12

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Results

Demographics:

General Anesthesia was used in 0.6%


Endovenous laser therapy for lower limb varicose veins13

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Results

Intervention :

Average voltage used 14.6W ( range 10 to 15W).


Endovenous laser therapy for lower limb varicose veins14

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Results

Concomitant avulsion phlebectomy

75.1% of limbs


Endovenous laser therapy for lower limb varicose veins15

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Results

Complications:

Significant bruising - 19%.

Superficial thrombophlebitis – 0.5%.

No edema, excessive pain, haematoma or cellulitis.

Thrombus protruding into the lumen of common femoral vein was seen in 11 limbs (1.3%)

Disappeared after 3 months.


Endovenous laser therapy for lower limb varicose veins16

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Results


Endovenous laser therapy for lower limb varicose veins17

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Preoperative

Preoperative

2 days PO

2 weeks PO

Results


Endovenous laser therapy for lower limb varicose veins18

Discussion

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Currently 82 articles have been published on RF obliteration and

EVLT for treating varicose veins

- English (68)

- French (14)

19 ------------ compared RF versus EVLT but no RCT.

7 ------------ compared RF versus HL + Stripping +/Stab Avulsion

including 4 RCT

1 ------------ compared RF, EVL, L+stripping


Endovenous laser therapy for lower limb varicose veins19

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Between Jan 1994 – Feb 2007

92% in the last 5 years

72 study arms, 81% prospective

7 RCTs

12320 limbs

2804 (23%) stripped

2126 (17%) UGFS

4876 (40%) EVLA

2514 (20%) RFA


Endovenous laser therapy for lower limb varicose veins20

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Meta-analysis


Meta analysis

Meta-analysis

Anatomical

Success

Rate


Endovenous laser therapy for lower limb varicose veins21

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Early technical success EVLT-Duplex findings<6months.


Endovenous laser therapy for lower limb varicose veins22

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Conclusion

EVLT treatment is coming closer to the goal of standardizing an effective method

for the treatment of varicose veins

Further controlled studies are required to compare optimized EVLT treatment protocols

with not only other endothermal modes of treatment but also with conventional open surgery


Endovenous laser therapy for lower limb varicose veins23

Endovenous Laser Therapy for Lower Limb Varicose Veins.

Conclusion

Early and intermediate results of EVLT are excellent.

Greater doses of energy delivered are associated with better results.

Long term follow - up is required to confirm the durability of EVLT.


Endovenous laser therapy for lower limb varicose veins24

Endovenous Laser Therapy for Lower Limb Varicose Veins.

King Khalid University Hospital


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