The influence of laser on varicose veins and its practical role in the endovascular laser obliteration (EVLO)

Abstract

Introduction: Modern phlebology supported a conceptual metamorphosis through the implementation o f the endovascular laser obliteration (EVLO). Of course, some aspects of the laser influence are yet to be explored, however our objective implied the study of the endovenous laser influence on the venous wall, through a practical use aspect. Materials and methods: The research was based on studying the in vitro laser impact on 12 vein fragments, which had been extracted intraoperative through stripping. We used a diode laser, model Valure S9 (940 nm wavelength). Results: We modeled, in vitro, the process of EVLO, during which 24 halves of veins were closed and 12 of them were filled with heparinized blood, while other 12 ones - with saline solution 0.9%. In the lumen of each vein we introduced a 600 mcm optical fiber, and applied an energy of 30 J/cm. In case o f veins filled with heparinized blood, the last one boiled, forming a gas, composed of blood combustion products. In addition, veins’ diameter did not decrease after chilling. The combustion products deposited on veins’ walls, which we histological proved after that. In case o f veins filled with sodium chloride 0.9%, the process of boiling happened more difficultly, and it decreased in diameter after cooling. Also, the laser impact on the vascular wall seemed to be much more reduced in veins with sodium chloride 0.9%, rather than in ones with heparinized blood. Conclusions: (1) The obliterative influence of laser on varicose veins happens, first of all, because the laser energy is absorbed by blood. (2) The blood vaporization takes place forming gas and combustion products. (3) In order to correctly accomplish the surgical intervention, it makes sense to realize an intraoperative procedure, named Troianov-Trendelenburg, which avoids the blood combustion products to migrate into the blood circuit.