Local cooling effect on perforation rates comparing the 980-1470 nm laser wavelengths used with endovenous laser ablation: double blind in vitro experimental study

Phlebology. 2014 Mar;29(2):120-5. doi: 10.1258/phleb.2012.012021. Epub 2013 May 6.

Abstract

Objective: Endovenous laser treatment (EVLA) is fast gaining acceptance as an alternative to open surgery for the treatment of saphenous vein incompetence. The method of action of these techniques is based on heat, making tumescence anaesthesia necessity. Heat-induced complications may occur with inadequate application of tumescent anaesthesia. Our hypothesis was, local cooling effect of tumescent anaesthesia on tunica adventitia might be kept undamaged from disruption due to the thermal injury.

Methods: We experimented with two popular laser wavelengths (980 and 1470 nm) and with two different thermal media (+4 and +24) in vitro for perforation. Twenty different 12 cm length vein pieces were numbered randomly to set up four groups of the experiment. Endovenous laser procedures were applied in same manner in a unique design test tube with same energy density per pieces on same duration (10 W/second) (linear endovenous energy density 60 J/cm). Procedure video was recorded for macroscopic perforations. All postprocedure vein segments were examined microscopically.

Results: Activities of both wavelengths were much better in cold medium (P < 0.05). Cold tumescent anaesthesia reduces the bleeding complication rate. But the performance of 1470 nm laser was better than that of 980 nm in cold environment (P = 0.0136).

Conclusions: It can be commented that reducing the ambient temperature is more beneficial than modifying the laser wavelength on perforation rates. Therefore we suppose tumescent anaesthesia temperature is effective on perforation independently from the wavelengths or type of the laser fibre.

Keywords: cold; endovenous laser ablation; perforation; thermal injury; tumescent anaesthesia.

Publication types

  • Comparative Study

MeSH terms

  • Anesthesia
  • Cold Temperature
  • Double-Blind Method
  • Hot Temperature
  • Humans
  • In Vitro Techniques
  • Laser Therapy / methods*
  • Lasers
  • Random Allocation
  • Saphenous Vein / surgery*
  • Veins / physiopathology
  • Venous Insufficiency / surgery*
  • Venous Insufficiency / therapy