Pannier Felizitas, Rabe E, Maurins U
Department of Dermatology, MUMC+ Maastricht, Maastricht, the Netherlands.
Vasa. 2010 Aug;39(3):249-55. doi: 10.1024/0301-1526/a000037.
Major side effects after endovenous laser ablation (EVLA) are pain and bruising. Low temperature of the tumescence fluid might cause additional venous constriction and a cooling effect around the vein. The aim of this study was to show outcome and side effects after EVLA of incompetent great saphenous veins (GSV) with a 1470 nm Diode laser (Ceralas E, biolitec) using cold or warm tumescence fluid for anaesthesia.
Between August and November 2007, 85 consecutive patients (85 legs) with an incompetent GSV were treated by EVLA. The patients were randomized in two groups. In 42 patients (Group A) a warm (37 degrees C) and in 43 patients (Group B) a cold (5 degrees C) tumescence fluid (TF) was used for local anaesthesia in the track of GSV. All patients were re-examined after 1, 10 and 30 days clinically and by duplex for complications and occlusion in the treated vein segment. Patient's satisfaction was assessed on a 0 to 4 points scale.
In each group one patient was lost to follow-up. There was no significant difference concerning gender, age, C of CEAP, BMI or diameter of the treated vein. In Group A a mean of 462 ml TF and in Group B a mean of 428 ml TF were used. In Group A the mean LEED (average linear endovenous energy density) was 114 J / cm and in Group B 115 J / cm. In both groups occlusion of the treated veins was achieved for all patients. The diameter of the GSV at 3 cm below the sapheno-femoral junction shrunk from 1.0 to 0.7 cm in both groups. The modified CEAP clinical score improved in Group A from 2.9 to 0.7 (mean value) and in Group B from 3.0 to 1.1. The mean pain score on a scale from 0 to 4 during day 2 to day 10 was 1.2 in Group A and 1.0 in Group B. At this time patients in Group A took a mean of 3.4 and in Group B 1.7 analgetic tablets. Ecchymoses were rare in both groups (4 in Group A, 7 in Group B).
In this prospective randomized comparative study the temperature of the tumescence fluid did not influence the occlusion rate when a high LEED was used. In both groups pain and ecchymoses are less frequent in this study with a 1470 nm diode laser than reported in studies with 810-980 nm systems. Cold tumescence fluid reduced pain slightly and reduced the intake of analgetics significantly.
静脉腔内激光消融术（EVLA）后的主要副作用是疼痛和瘀斑。肿胀液温度过低可能会导致额外的静脉收缩以及静脉周围的冷却效应。本研究的目的是展示使用1470纳米二极管激光（Ceralas E，拜奥泰克公司），采用冷或温肿胀液进行麻醉，对大隐静脉（GSV）功能不全患者进行EVLA后的治疗效果和副作用。
2007年8月至11月期间，对85例（85条腿）大隐静脉功能不全的患者连续进行了EVLA治疗。将患者随机分为两组。42例患者（A组）使用温热（37摄氏度）肿胀液，43例患者（B组）使用冷（5摄氏度）肿胀液，在大隐静脉走行部位进行局部麻醉。所有患者在术后1天、10天和30天进行临床复查，并通过双功超声检查治疗静脉段有无并发症和闭塞情况。采用0至4分的评分量表评估患者满意度。
每组各有1例患者失访。两组患者在性别、年龄、CEAP分级中的C级、体重指数或治疗静脉直径方面无显著差异。A组平均使用462毫升肿胀液，B组平均使用428毫升肿胀液。A组平均线性静脉内能量密度（LEED）为114焦/厘米，B组为115焦/厘米。两组所有患者的治疗静脉均实现了闭塞。两组患者大隐静脉股静脉交界处下方3厘米处的直径均从1.0厘米缩小至0.7厘米。A组改良CEAP临床评分从2.9改善至0.7（平均值），B组从3.0改善至1.1。术后第2天至第10天，A组0至4分疼痛评分平均值为1.2，B组为1.0。此时，A组患者平均服用3.4片镇痛药，B组为1.7片。两组瘀斑均较少见（A组4例，B组7例）。
在这项前瞻性随机对照研究中，当使用高LEED时，肿胀液温度不影响闭塞率。在本研究中，与810 - 980纳米系统的研究报道相比，采用1470纳米二极管激光治疗时，两组患者的疼痛和瘀斑发生率均较低。冷肿胀液可轻微减轻疼痛，并显著减少镇痛药的服用量。
