More Successful Results with Less Energy in Endovenous Laser Ablation Treatment: Long-term Comparison of Bare-tip Fiber 980 nm Laser and Radial-tip Fiber 1470 nm Laser Application

摘要

Background Varices and venous insufficiency are common and serious health problems in the general population which affect the quality of life. Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux, and the endovenous laser ablation (EVLA) method has been widely accepted all over the world. In this method, ablation is provided by a laser fiber inserted into the lumen of the vein. Initially, the fibers were 810?nm, but today the fibers are usually 940, 980, or 1470?nm. Methods The study included 400 patients (419 procedures) who were diagnosed with venous insufficiency and underwent 980 and 1470?nm EVLA. Patients were followed up for 48?months. A 980-nm bare-tip laser catheter in Group A and a 1470-nm radial-tip laser catheter in Group B were inserted until they were 2?cm below the saphenofemoral junction. An EVLA catheter was drawn slowly at the rate of 1–3 cm/sec (2.08?±?0.6). The energy applied to the saphenous vein was 60–120?J/cm (84.65?±?13.03) and 45–120?J/cm (76.95?±?15.06) in Group A and Group B, respectively ( P ? ? pain scale (0–10). Postoperative complications were recorded. Results Group A (980?nm laser) consisted of 200 patients with a mean age of 37.84?±?12.2?years. Group B (1470?nm laser) consisted of 200 patients with a mean age of 38.38?±?12.1?years. The mean duration of the procedure was 32.2?±?9.7?min in Group A and 31.7?±?8.8?min in Group B, respectively ( P ?=?0.47). Induration, ecchymosis, and paresthesia rates were significantly higher in the bare-tip laser group. The most important complication, deep vein thrombosis, was observed in 4 patients in Group A. Recanalization rates were found to be increased by prolonged follow-up periods. At the 48-month follow-up, this rate was 15.9% in Group A and 8.3% in Group B ( P ?=?0.017). This rate showed that the 1470-nm wavelength laser treatment was more successful in Group B than in Group A over the long term. Conclusions Both the 980 and 1470?nm wavelength laser-assisted EVLA procedures appear to be effective in treating saphenous vein insufficiency. The 1470-nm radial-tip fiber is preferred due to lower energy levels, lower complication rates, early return to daily life, and the successful long-term occlusion rate.