Endovenous laser treatment: is there a clinical difference between using a 1500 nm and a 980 nm diode laser? A multicenter randomised clinical trial.

AIM: We compared the use of two different laser wavelengths in the treatment of great saphenous vein (GSV) reflux: the 1500 nm versus the 980 nm diode laser. We studied the occlusion rates and noted possible side-effects. METHODS: In three centers 180 great saphenous veins were treated with endovenous laser ablation (EVLA). By random selection half of the patients were treated with a 980 nm laser and half with a 1500 nm laser. A Duplex scan was scheduled at one month and six months postoperatively. Ecchymosis was measured at one week using a calculated scale. In addition the need for analgesics, the induration around the treated vein and patient satisfaction rate were noted. At two weeks postoperatively a quality of life score (CIVIQ2) was obtained. RESULTS: The complete occlusion rates at six months were not statistical significant different between both groups (95.5% for 980 nm and 93.1% for 1500 nm). Most of the non-occluded veins had a filiform internal lumen and did not show reflux. There was no significant difference in the postoperative appearance of ecchymosis (P=0.09). Patients treated with a 1500 laser had less induration around the treated vein (P=0.002), less need to take analgetics (1.8 days versus 2.9 days) and had a better postoperative quality of life (P=0.018). The patient satisfaction rate did not differ in the two groups. CONCLUSION: Using a 1500 nm diode laser in the treatment of an incompetent GSV, compared to the use of a 980 nm laser, results in similar occlusion rates at six months, but somewhat less side-effects.

[Thromboendarterectomy of the superficial femoral artery with a femoro-popliteal endoprosthesis. Technical note on a preliminary experience]. / La Tromboendoarteriectomia (TEA) dell'arteria femorale superficiale (SFA) con posizionamento di endoprotesi femoro-poplitea. Note di tecnica su una esperienza preliminare.

BACKGROUND: The authors report an early experience with a new endovascular approach in the treatment of occlusive superficial femoral artery disease to evaluate the efficacy and the feasibility of the new technique. METHODS AND RESULTS: Four patients with disabling claudication or leg rest pain were treated for long segment occlusion of superficial femoral artery (SFA). A remote endarterectomy (EA) of SFAs has been performed using a single groin incision and a conventional Vollmar ring stripper to remove the entire atheroma core for a length of 20, 10, 9 and 8 cm. In 3 cases following complete extraction of intimal core and a guidewire placement across from the distal endpoint, the endarterectomized segment was lined endoluminally by implanting one or more Self-Expanding Coated Stent (Meadox Passager 6-10 mm); the stent was positioned under fluoroscopic guidance to prevent dissection without any further balloon-dilation. In 1 case a 5 mm diameter thin-walled PTFE endoluminal graft was positioned using a Strecker stent for distal fixation. One patient had an immediate post-operative occlusion of distal stent which required a femoro-popliteal autologous vein bypass. In the remaining 3 cases no postoperative complications were observed and the patients are asymptomatic with normal flow through the stent and the endoluminal PTFE graft at 6 months. CONCLUSIONS: In this report a combined surgical and endovascular procedure has been proposed. A prospective randomized study is carrying on at our Institute to verify if EA+ endovascular grafting of SFA represents an alternative to traditional femoro-popliteal vein bypass.