Endovenous laser

Abstract

Endovenous laser or EVLT is a recent technique for
endovascular sclerosis of venous axis by thermal effect.
Since the first publications of Dr C Bone (1997) and Min RJ
(1999) with 810 nm, the technique has been refined for
both parameters (wavelength, transmission time, energydelivered, distribution linear and radial light), as well as
hardware and instructions.
The thermal effect is based on three steps responding in
part to precise physical laws:
✔ Conversion of light into heat (absorption and diffusion),
✔ Heat transfer to the tissues (blood, wall and perivenous) of a primary volume after firing to a secondary
volume, thermally affected (thermodynamics tissue
and cell),
✔ Change thermochemical (iso-damage curves and histology).
The histological works have the following findings:
endoluminal thrombus, intimal injury (edema, disruption,
endothelial detachment, injury of ligands), intimo-medial
section, coagulation necrosis, medial lesions (alteration and
shrinkage of collagen, edema, vacuolization, nuclear
lesions), adventitial lesions (holes of the fiber in contact
with the wall, parietal disruption by thermomechanical
effect), peri-adventitial haemorrhages, lymphoceles. The
LEV enables real “endo-phlebectomy and intimectomies” to
a depth of 100 to 900 microns.
The indications are now many published: the great
saphenous and small saphenous vein, the saphenous
branches, perforators, ulcers, surgical recurrence (CHIVA
included),venous malformations.
The main side effects described (in order of frequency):
indurations, hematomas and bruises
paraesthesia and dysaesthesia (especially with leg vein
endosclerosis), superficial and deep venous thrombosis,
recanalization, hyperpigmentation, lymphoceles, burns, secondary infections (cellulitis), arteriovenous fistulas, stroke.
An ultrasound classification was developed to better
assess the impact of different laser parameters
The wavelengths used: 810 nm has been supplanted by
the 980 nm and 940 nm, better adapted to the absorption
by hemoglobin and water. These have been studies of longer
follow-up to say 3 to 6 years basically.
LEV compared to surgery: the practice of LEV associated
with phlebectomy allows better results without additional
complications. These can be replaced by endovenous treatment, the period of sick leave and hospitalization is reduced
in some studies, as well as postoperative pain and recurrence rate. Local anesthesia and locoregional are more
common with the LEV. Meta-analysis (12 320 members followed to 3 years) call for the LEV with a success rate of 94%
for LEV, 84% for RF, 78% for stripping and 77% for the
foam. The recurrence rate is lower in the absence of ligation.
LEV and sclerosis: the LEV is working occlusion above
the GVS sclerosis. Ultrasound-guided sclerotherapy after
procedure improves the rate of secondary occlusion in the
long term, it remains competitive with the LEV for the small
saphenous vein.
LEV compared to radiofrequency : recanalization rates
in favor of LEV. The comparative scales of pain and period
with induration are in favor of the RF.
Conclusion: LEV appears to be the technique of choice
for the treatment of great saphenous vein, it is discussed
with ultrasound-guided sclerotherapy for the small saphenous vein. Its efficiency published meta-analysis, probably
due to the fact that the absence of ligation of the saphenofemoral junction saves angiogenesis described with conventional ligation. It fits perfectly in the context of an outpatient procedure with regard to vector-saving reduction of
sick leave, prescription of analgesics and the number of sessions of sclerotherapy.
We find its global leadership and the many publications
and as evidenced by the recent recommendations (2011) of
the American Venous Forum. Methodological rigor and relevant analysis of the quality of life should finally convince
our health authorities