Pannier F, Rabe E, Maurins U
Academisch Ziekenhuis Maastricht azM, Afdeling Dermatologie, Postbus 5800, AZ Maastricht, 6202, The Netherlands.
Phlebology. 2009 Feb;24(1):26-30. doi: 10.1258/phleb.2008.008038.
Most of the published EVLA data concern 810, 940, 980 nm diode lasers and 1064 or 1320 nm Nd:Yag laser systems. Major side effects are postoperative pain and bruising. The aim of this study was to show the outcome one year after EVLA of incompetent saphenous veins with a 1470 nm Diode laser (Ceralas E, biolitec).
Between December 2006 and February 2007, 134 saphenous veins (108 GSV, 26 SSV) in 117 legs of 100 consecutive patients where treated by EVLA for GSV and SSV incompetence. All patients were examined clinically and with duplex by an experienced phlebologist prior to intervention, and at the follow-up visits for complications, occlusion, flow and reflux in the treated vein segment. The clinical evaluation included clinical CEAP and the presence of recurrent varicose veins. Patient satisfaction was assessed by a 0 to 4 scale.
After a mean follow-up period of 184 days (SD 27) 127 treated veins (102 GSV, 25 SSV) of 111 limbs in 94 patients and after 329 days (SD 14) 105 treated veins (94 GSV, 21 SSV) of 105 limbs in 83 patients were reinvestigated. Six patients were lost to follow up after six months and an additional 11 patients after one year. Up to one year follow-up all treated veins remained occluded. At six months, one new insufficient anterior accessory saphenous vein (AASV) and after 12 months, three new insufficient AASV occurred. After one year 45 patients were very satisfied with the method, 34 were satisfied, three were fairly and one was not satisfied. The mean of all answers was 0.5 (SD 0.5). In three cases phlebitic reactions after 10 days, but no severe complications such as deep vein thrombosis occured. After six months in 9.5% of the legs paresthesia was present in the treated area which reduced to 7.6% after one year. Intake of painkillers was mean 6.7 tablets (SD 3.5). When we compared GSV legs treated with LEED below or above 100 J/cm, the paresthesia rate was significantly lower in the first group with 2.3% compared to 15.5 % in the higher LEED group. The differences for number of days with analgesic intake and for the paraesthetic area were significant. Discussion In this prospective follow-up study with 100 consecutive patients and 134 treated saphenous veins a high occlusion rate of 100% could be demonstrated one year after treatment. However, with LEED > 100 J/cm in this study, the incidence of paresthesia rose significantly. Therefore it seems adequate to stay below 100 J/cm in the future as the occlusion rate was the same below and above 100 J/cm.
EVLA of GSV and SSV with a 1470 nm diode laser is a minimally invasive, safe and efficient therapy option with a high success rate.
大多数已发表的腔内激光消融术（EVLA）数据涉及810、940、980纳米二极管激光器以及1064或1320纳米钕：钇铝石榴石激光系统。主要副作用是术后疼痛和瘀伤。本研究的目的是展示使用1470纳米二极管激光器（Ceralas E，伯乐泰克）对大隐静脉功能不全进行腔内激光消融术后一年的结果。
在2006年12月至2007年2月期间，对100例连续患者的117条腿中的134条大隐静脉（108条大隐静脉主干，26条小隐静脉）进行腔内激光消融术治疗，以解决大隐静脉主干和小隐静脉功能不全问题。所有患者在干预前均由经验丰富的静脉病专家进行临床检查和双功超声检查，并在随访时检查治疗静脉段的并发症、闭塞情况、血流和反流情况。临床评估包括临床CEAP分级和复发性静脉曲张的存在情况。通过0至4级评分评估患者满意度。
在平均随访184天（标准差27天）后，对94例患者111条肢体中的127条治疗静脉（102条大隐静脉主干，25条小隐静脉）进行了复查，在329天（标准差14天）后，对83例患者105条肢体中的105条治疗静脉（94条大隐静脉主干，21条小隐静脉）进行了复查。6例患者在6个月后失访，另有11例患者在1年后失访。直至随访一年，所有治疗静脉均保持闭塞。在6个月时，出现1条新的前副大隐静脉功能不全，在12个月时，出现3条新的前副大隐静脉功能不全。一年后，45例患者对该方法非常满意，34例满意，3例一般满意，1例不满意。所有回答的平均值为0.5（标准差0.5）。3例在10天后出现静脉炎反应，但未发生深静脉血栓形成等严重并发症。6个月时，9.5%的腿部治疗区域出现感觉异常，一年后降至7.6%。止痛药的平均服用量为6.7片（标准差3.5）。当我们比较以低于或高于100焦耳每平方厘米的激光能量密度（LEED）治疗大隐静脉主干的腿部时，第一组的感觉异常率显著较低，为2.3%，而高激光能量密度组为15.5%。止痛药服用天数和感觉异常区域的差异具有显著性。讨论 在这项对100例连续患者和134条治疗大隐静脉的前瞻性随访研究中，治疗后一年可证明闭塞率高达100%。然而，在本研究中，当激光能量密度>100焦耳每平方厘米时，感觉异常的发生率显著上升。因此，由于100焦耳每平方厘米以下和以上的闭塞率相同，未来似乎保持在100焦耳每平方厘米以下是合适的。
使用1470纳米二极管激光器对大隐静脉主干和小隐静脉进行腔内激光消融术是一种微创、安全且有效的治疗选择，成功率高。
