Endovenous laser ablation of saphenous veins - favorable clinical results confirm theoretical advantages of the 1940nm diode laser
Abstract
Introduction: Endovenous laser ablation (EVLA) is a recognized alternative to surgical treatment of varicose veins, although an optimal laser generator and its settings still remain a matter of debate. The aim of our study was to correlate clinical results with the theoretical advantage of the 1940nm diode laser characterized by high absorption of heat in a thin layer of coagulated tissue.
Methods: From 1/2010 to 12/2021 EVLA was performed in a total of 3529 consecutive patients with varicose veins and ultrasonographically documented superficial venous reflux of lower extremities. Three types of laser were used successively with the wavelengths of 1064 nm, 1470 nm and 1940 nm, respectively. All patients were prospectively enrolled in our registry. An early postoperative follow-up visit was scheduled including an assessment of venous closure; additional visits were performed only in case of complications.
Results: The success of venous closure did not differ (p=0.054) between the three laser types and was over 98%. The catheter-based method made it possible to perform multiple ablations in one procedure - the trend was 1.08, 1.31 and 1.62. In 2021 the number of ablations per patient with the laser DL Tethys 1940 nm was 1.79. With this laser it was possible to reduce the total energy applied to one half (8 W, 50-80 J/cm). The postoperative course of patients treated using the 1940nm laser was smoother - no other but the early follow-up visit was needed in 95.6% cases (p<0.001).
Conclusion: This study showed that all three types of the near-infrared lasers had an equal closure efficacy. With the 1940nm DL it was possible to decrease the energy to one half. Despite multiple ablations performed in one procedure the postoperative course of the patients was smoother.