The endovascular laser obliteration (evlo) in the treatment of varicose veins

Abstract

Introduction: The varicose disease has a great impact upon human life and maintains leading positions among surgical pathologies of blood vessels. During the last years, phlebology supported significant changes in the approach of varicose veins, and one of the best achievements was the invention of the endovenous laser and the further development of EVLO. Materials and Methods: Our study included 203 patients with varicose disease C2-C6 according to CEAP classification, treated with EVLO during 2011-2015 years, using a diode laser, model Velure S9 (980 nm wavelength). The research was based on evaluating the effectiveness of EVLO in the treatment of lower limbs varicose veins, as well as studying the in vitro laser impact on blood vessels’ walls and blood components. Discussion results: In the experimental part significant results were shown in case of the veins filled with heparinized blood. The blood boiled forming a gas and combustion products, which resulted in vascular ablation, in contrast with no change in other ones. In the clinical part we treated 203 patients with varicose veins, using EVLO combined with crossectomy and Müller miniflebectomy. All interventions were completed successfully. The average hospital stay was about 1 day. The most common early manifestations were low grade fever within first 24 hours and postoperative moderate pain, which were solved by administration of anti-inflammatory drugs, and hyperpigmentation of the skin, which have been solved independently during 1,5 to 6 months. The installation of aseptic phlebitis and skin hyperpigmentation was more frequently in patients with GSV diameter > 10mm. During late period, recanalization of GSV occurred in 4 cases (1,97%) and segmentary recurrences of varicose veins in 6 cases (2,96%), which was less than in the literature data. Also, our tactics and new techniques implementation allowed us to change and extend the indications.Conclusions: (1) The endovenous laser has an effective action of coagulation and obliteration upon blood vessels, which allows to use it efficiently in the treatment of varicose veins. (2) EVLO allows the ablation of saphenian trunk in most cases, with a minimal trauma and fast recovery of the patient.(3) The complications’ rate, such as phlebitis and recanalization, increases with blood vessels’ diameter, and it is also difficult to perform the procedure in case of sinuous veins. (4) In order to avoid complications and to increase the effectiveness of EVLO, it is indicated to perform it in association with crossectomy and miniflebectomy.