Teter Katherine A, Kabnick Lowell S, Sadek Mikel
Department of Surgery, NYU Langone Health, New York City, NY, USA.
Atlantic Health, Morristown Medical Center, Kabnick Vein Center, Morristown, NJ, USA.
Phlebology. 2020 Oct;35(9):656-662. doi: 10.1177/0268355520937619. Epub 2020 Jul 6.
To provide an evidence-based overview of endovenous laser ablation and describe its role as an effective and durable technique for the management of superficial venous insufficiency.
The published literature on the treatment of varicose veins using endovenous laser ablation was reviewed. The literature search focused on the history of endovenous laser ablation, its safety and durability, known complications, and differences in outcomes based on the iterations of fiber type and laser wavelength.
Treatment safety and efficacy of endovenous laser ablation appear to be based on the amount of energy administered over a defined distance, or the linear endovenous energy density. The ideal linear endovenous energy density varies with the laser wavelength and fiber-type. Post-operative pain and bruising may be reduced by the use of higher wavelength fibers or the use of radial or jacket-tip fibers as compared to bare-tip fibers. The incidence of endothermal heat-induced thrombosis remains low and has declined with increasing experience. Reports have demonstrated a greater than 90% technical success rate with saphenous endovenous laser ablation, long-term durability of ablation, and commensurate improvement in quality of life.
Endovenous laser ablation is a safe and durable treatment option for the management of incompetent superficial and perforator veins of the lower extremities. As an endothermal technology, it remains a key component of the standard of care for the treatment of chronic venous insufficiency.
提供基于证据的静脉腔内激光消融概述，并描述其作为治疗浅静脉功能不全的有效且持久技术的作用。
回顾了已发表的关于使用静脉腔内激光消融治疗静脉曲张的文献。文献检索重点在于静脉腔内激光消融的历史、其安全性和持久性、已知并发症以及基于光纤类型和激光波长迭代的结果差异。
静脉腔内激光消融的治疗安全性和有效性似乎基于在规定距离内施加的能量量，即线性静脉能量密度。理想的线性静脉能量密度随激光波长和光纤类型而变化。与裸尖光纤相比，使用更高波长的光纤或径向或护套尖端光纤可减少术后疼痛和瘀伤。内热诱导血栓形成的发生率仍然较低，并且随着经验的增加而下降。报告显示大隐静脉腔内激光消融的技术成功率超过90%，消融具有长期持久性，并且生活质量有相应改善。
静脉腔内激光消融是治疗下肢浅静脉和交通静脉功能不全的安全且持久的治疗选择。作为一种内热技术，它仍然是慢性静脉功能不全治疗标准护理的关键组成部分。
