56 - Communication libre
Vascular Access / Vein
3 juin 2021, 17:35 - 19:05, Stream 3: SSCVasculaire & SSCViscérale
Initial single surgeon experience in the endovenous thermal ablation of saphenous veins using the new 1940 nm laser fiber
G. Gemayel, Presenter: G. Gemayel (Meyrin)
The endovenous thermal ablation of varicose veins has become the gold standard in the treatment of saphenous vein incompetence. Among the two widely used techniques (radiofrequency and laser), laser technology has witnessed a lot of evolution since its adoption, mainly in the wavelength of the laser beam. We evaluate a new laser fiber of 1940 nm wavelenght, which is the highest on the market, in an office-based varicose vein clinic.
Between january 2020 and december 2020, data of all patients treated by a single surgeon using the 1940 nm laser fiber (Simla6, Tutzing, Germany) in an office-based clinic under local tumescent anesthesia were collected. Patients were followed at day 1 and day 7 post operatively with an ultrasound and at 6 and 12 months. Primary endpoints were technical success and closure rate, secondary endpoints were occurence of endothermal heat induced thrombosis (EHIT), any deep vein thrombosis (DVT) and reopening of the treated vein.
97 patients with 141 saphenous veins were included in the study. 82 were females. Mean age was 49 years (19-81), mean VCSS classification was 5.55 (4-9), mean saphenous vein diameter was 6.7 mm (3.5-12), mean treated lenght was 35.6 cm (15-70). The power setting was adapted to vein diameter and ranged between 1.5 and 4 watts yielding a mean linear endovenous energy intensity of 29.52 j/cm (15.36-46.5). All patients had a one day and one week ultrasound follow-up and 40 patients were seen at one year. Technical success was achieved in all patients with a 100% closure rate at one week follow-up. There was two cases of type I EHIT not necessitating any further treatment and one case of type II EHIT that resolved after 4 weeks of anticoagulation therapy. One patient had a segmental reopening of his treated vein at one week that persisted at two months follow-up with no clinical symptoms and no further additional treatment. All 40 patients seen at one year had a persistent closure of their treated vein. No DVT was noted.
The new 1940 nm laser fiber has an excellent short and mid term results in the treatment of saphenous vein with less energy delivery compared to shorter wavelength fibers. Longer follow-up are needed to confirm these results.