Improving Endovenous Laser Ablation Results

Rosemont, Illinois, September 22, 2021 – A single-center, prospective, randomized trial suggests that endovenous laser ablation (EVLA) using a 1470-nm laser with a bare fiber (BF) provided outcomes in the short term similar to those using a radial fiber (RF).

Endothermal ablation has revolutionized the treatment of great saphenous vein (GSV) varicosities over the past two decades. This is accomplished via delivery of either radiofrequency or laser energy to the vein wall.

According to principal investigator Harishankar Ramachandran Nair, MS, MRCSEd, MCh, from the Starcare Hospital in Calicut, Kerala, India, “Studies performed over the past few years using a diode laser showed slightly better occlusion rates and overall success rates compare with radiofrequency ablation, especially for veins with large diameters.” 

“EVLA, however, is not free of complications,” Nair continues, “most often including pain and bruising in the lower limb along the ablated vein. One of the main reasons for this has been thought to be vein wall perforation from the laser heat, the incidence of which is greater with conventional bare fibers.” 

He notes, “Significant data comparing use of BFs and RFs with the 1470-nm diode laser are lacking.  The aim of our trial was to directly compare these modalities, specifically looking at venous clinical severity score (VCSS).”

As reported in the September 2021 issue of the Journal of Vascular Surgery: Venous and Lymphatic Disorders, the researchers randomized at total of 86 patients with primary GSV varices into treatment with the BF (n=43) versus RF (n=46) from January to December 2019.

Clinical data between the two groups included:

• Vein size: BF 5.74 +/- 1.7mm versus RF 5.24 +/- 1.0mm (P=.31)
• VCSS: BF 7.7 versus RF 6.8 (P=.27)

Following treatment, no recanalization of the treated GSV was noted by ultrasound at one month.

Pain was assessed by an analog scale from 1 to 10.  The post-procedural scores were assessed at two points:

• 8 hours: BF 2.77 versus RF 2.70 (P=.83)
• 1 week : BF 2.81 versus 2.74 (P=.87)

Finally, there was notable improvement in the VCSS scores post-procedure:

• BF.  2.49 +/- 1.2 versus
• RF  3.27 +/- 2.2 (P=.054)

Nair comments, “The RF and longer wavelength (1470-nm) laser were introduced to mitigate the local complications of the conventional BF and their use has been reported to result in less recurrence. Very few studies, however, have compared outcomes such as postoperative pain, ecchymosis and recurrence in BF vs RF.

“Despite reported advantages of the RF, some disadvantages do exist compared with the BF for EVLA. The optical fiber of the RF has a larger outer diameter of 1.85mm compared with the smaller 600um BF, making the former stiffer. This can make it more difficult to track an RF through tortuous or aneurysmal veins.”

The authors conclude that there were no significant differences in postoperative pain or improvement in the VCSS at 30 days between the two modalities. Furthermore, the BF can be effectively used at a lower power (7W) and similar linear endovenous energy density compared with RF, and can be a useful tool for difficult EVLA.

This randomized trial included 86 patients, revealing equivalent short-term results for the two lasers and providing the practitioner with data supporting the use of both modalities in varying clinical situations.

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About the Society for Vascular Surgery

The Society for Vascular Surgery is the leading not-for-profit, professional medical society on establishing causes and treatments for vascular disease. SVS seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness and is composed of specialty-trained vascular surgeons who are dedicated to providing comprehensive care for vascular disease. For more information visit www.vascular.org. Follow the SVS on Facebook @VascularHealth, Twitter @VascularSVS and Instagram @societyforvascularsurgery.