Setia Abhay, Dikic Slobodan, Demhasaj Sahit, Schmitz-Rixen Thomas, Sroka Ronald, Schmedt Claus-Georg
Department of Vascular Surgery, Diakonie-Klinikum, 74523 Schwaebisch Hall, Germany.
Division of Vascular and Endovascular Surgery, Department of Vascular Medicine, Klinikum Darmstadt, 64283 Darmstadt, Germany.
J Clin Med. 2023 Jun 27;12(13):4313. doi: 10.3390/jcm12134313.
Heterogeneity regarding dosimetry and reporting of endovenous laser ablation (EVLA) mandates the development of a standardized protocol. This study presents the mid-term results of EVLA with 1940 nm-laser and radial-fibre, supported by a four-zone dosimetry tool.
Four anatomical dosimetry zones for great saphenous veins (GSV) and two for small saphenous veins (SSV) were defined with set power levels. Zone-1G (4 W) extended from the inguinal ligament to the apex of femoral triangle, Zone-2G (4 W) from the apex of femoral triangle to the upper border of patella. Zone-3G (3 W) from the patella to the tibial tuberosity. Zone-4G (2 W) extended from the tibial tuberosity to the ankle. Zone-1S from the sapheno-popliteal junction to the tibial tuberosity. Zone-2S from the tibial tuberosity to the ankle. Power was increased by 1 W for veins >10 mm and decreased by 1 W when fibre sticking was encountered. Pullback-velocity was max. 1 mm/s.
A total of 152 consecutive patients (185 procedures) were recruited. Mean follow-up time was 11.9 months. Mean linear endovenous energy density for GSV was Zone-1G:42 J/cm, Zone-2G:33 J/cm, Zone-3G:27 J/cm, Zone-4G:22 J/cm, Zone-1S:34 J/cm, Zone-2S:27 J/cm. Occlusion rates were 98.9% (1-month) and 93.7% (12-months). Complications at 1 M were low, namely laser-induced paraesthesia (LIP) 2.2% and endovenous heat-induced thrombosis (EHIT) 1.6%. Persistent LIP (12 M) was observed in 0.5%.
The proposed four-zone guiding tool is a step towards standardizing dosimetry and documentation for EVLA with 1940 nm. This strategy shows good mid-term results with minimal complications. Long-term follow-up and application in further centres are necessary to prove its reproducibility. Such a guiding tool could improve the ability to analyse, compare and review different EVLA wavelengths and fibre types.
静脉腔内激光消融术（EVLA）在剂量测定和报告方面存在异质性，这就需要制定标准化方案。本研究展示了在四区剂量测定工具支持下，使用1940纳米激光和径向光纤进行EVLA的中期结果。
为大隐静脉（GSV）定义了四个解剖剂量测定区，为小隐静脉（SSV）定义了两个区，并设定了功率水平。1G区（4瓦）从腹股沟韧带延伸至股三角顶点，2G区（4瓦）从股三角顶点延伸至髌骨上缘。3G区（3瓦）从髌骨延伸至胫骨结节。4G区（2瓦）从胫骨结节延伸至踝关节。1S区从隐静脉-腘静脉交界处延伸至胫骨结节。2S区从胫骨结节延伸至踝关节。对于直径大于10毫米的静脉，功率增加1瓦；遇到光纤粘连时，功率降低1瓦。回撤速度最大为1毫米/秒。
共纳入152例连续患者（185例手术）。平均随访时间为11.9个月。GSV的平均线性静脉内能量密度为：1G区：42焦/厘米，2G区：33焦/厘米，3G区：27焦/厘米，4G区：22焦/厘米，1S区：34焦/厘米，2S区：27焦/厘米。闭塞率为98.9%（1个月）和93.7%（12个月）。1个月时的并发症发生率较低，即激光诱导感觉异常（LIP）为2.2%，静脉内热诱导血栓形成（EHIT）为1.6%。12个月时观察到持续性LIP的发生率为0.5%。
所提出的四区引导工具是朝着使1940纳米EVLA的剂量测定和记录标准化迈出的一步。该策略显示出良好的中期结果，并发症最少。需要进行长期随访并在更多中心应用，以证明其可重复性。这样的引导工具可以提高分析、比较和审查不同EVLA波长和光纤类型的能力。
