Randomized clinical trial of 940- versus 1470-nm endovenous laser ablation for great saphenous vein incompetence.

BACKGROUND: The independent effect of wavelength used for endovenous laser ablation (EVLA) on patient-reported outcomes, health-related quality of life (HRQoL), treatment success and complications has not yet been established in a randomized clinical trial. The aim was to compare two different wavelengths, with identical energy level and laser fibres, in patients undergoing EVLA. METHODS: Patients with great saphenous vein incompetence were randomized to receive 940- or 1470-nm EVLA. The primary outcome was pain at 1 week. Secondary outcomes were: patient satisfaction, duration of analgesia use and time without normal activities assessed at 1 week; HRQoL after 12 weeks; treatment success after 12 and 52 weeks; change in Venous Clinical Severity Score (VCSS) after 12 weeks; and adverse events at 1 and 12 weeks. RESULTS: A total of 142 legs were randomized (940-nm EVLA, 70; 1470-nm EVLA, 72). Patients in the 1470-nm laser group reported significantly less pain on a visual analogue scale than those in the 940-nm laser group: median (i.q.r.) score 3 (2-7) versus 6 (3-8) (P = 0.004). Duration of analgesia use was significantly shorter after 1470-nm EVLA: median (i.q.r.) 1 (0-3) versus 2 (0-5) days (P = 0.037). HRQoL and VCSS improved equally in both groups. There was no difference in treatment success rates. Complications were comparable in both groups, except for more superficial vein thrombosis 1 week after 1470-nm EVLA. CONCLUSION: EVLA using a 1470-nm wavelength fibre was associated with improved postoperative pain and a reduction in analgesia use in the first week after surgery compared with use of a 940-nm fibre. Treatment success and adverse event rates were similar. REGISTRATION NUMBER: NCT01637181 (http://www.clinicaltrials.gov).

Multiple venous aneurysms in a patient with hypereosinophilic syndrome.

Hypereosinophilic syndrome (HES) is a diverse group of rare disorders, defined by persistent peripheral blood eosinophilia (>1500 per mm(3)), the absence of a primary cause of eosinophilia (such as parasitic or allergic disease), and evidence of eosinophil-mediated end-organ damage. Arterial aneurysms have been previously reported in these patients. This is the first report of a patient with HES and multiple venous aneurysms, causing recurrent pulmonary thromboembolism. Venous aneurysms can represent eosinophil-mediated, potentially fatal end-organ damage in patients with HES.

Randomized clinical trial of endovenous laser ablation versus steam ablation (LAST trial) for great saphenous varicose veins.

BACKGROUND: The aim was to compare endovenous laser ablation (EVLA) and endovenous steam ablation (EVSA) for great saphenous varicose veins in a non-inferiority study. METHODS: Patients with primary great saphenous vein reflux were randomized to EVLA (940 nm) or EVSA (SVS™). Primary outcomes were treatment success (vein obliteration or abolition of reflux) [corrected] at 52 weeks, and Venous Clinical Severity Score (VCSS) at 12 weeks. Secondary outcomes were pain, satisfaction with treatment, duration of analgesia use and days lost from daily activities, changes in Aberdeen Varicose Vein Questionnaire (AVVQ) and EQ-5D™ scores after 12 weeks, and complications at 2 and 12 weeks. RESULTS: A total of 227 legs were treated (EVSA, 117; EVLA, 110); 36 legs treated with EVSA received a low dose and the remaining 81 a higher dose. At 1 year, the treatment success rate after high-dose EVSA was not inferior to that of EVLA: 92 (95 per cent confidence interval (c.i.) 86 to 98) versus 96 (92 to 100) per cent respectively. Changes in VCSS after 12 weeks were similar: -2·69 (95 per cent c.i. -2·34 to -3·04) and -2·51 (-2·10 to -2·93). AVVQ, EQ-5D™ and EQ VAS scores improved equally 12 weeks after both treatments. Patients treated with EVSA reported less postprocedural pain, fewer days of analgesia use, were more satisfied with therapy, and had a shorter convalescence. Complication rates were comparable. CONCLUSION: The 1-year treatment success of high-dose EVSA was not inferior to that of EVLA. Several secondary outcomes were in favour of EVSA. Registration number NCT02046967 (http://www.clinicaltrials.gov).

Temperature profiles of 980- and 1,470-nm endovenous laser ablation, endovenous radiofrequency ablation and endovenous steam ablation.

Endovenous thermal ablation (EVTA) techniques are very effective for the treatment of varicose veins, but their exact working mechanism is still not well documented. The lack of knowledge of mechanistic properties has led to a variety of EVTA protocols and a commercially driven dissemination of new or modified techniques without robust scientific evidence. The aim of this study is to compare temperature profiles of 980-and 1,470-nm endovenous laser ablation (EVLA), segmental radiofrequency ablation (RFA), and endovenous steam ablation (EVSA). In an experimental setting, temperature measurements were performed using thermocouples; raw potato was used to mimic a vein wall. Two laser wavelengths (980 and 1,470 nm) were used with tulip-tip fibers and 1,470 nm also with a radial-emitting fiber. Different powers and pullback speeds were used to achieve fluences of 30, 60, and 90 J/cm. For segmental RFA, 1 cycle of 20 s was analyzed. EVSA was performed with two and three pulses of steam per centimeter. Maximum temperature increase, time span of relevant temperature increase, and area under the curve of the time of relevant temperature increase were measured. In all EVLA settings, temperatures increased and decreased rapidly. High fluence is associated with significantly higher temperatures and increased time span of temperature rise. Temperature profiles of 980- and 1,470-nm EVLA with tulip-tip fibers did not differ significantly. Radial EVLA showed significantly higher maximum temperatures than tulip-tip EVLA. EVSA resulted in mild peak temperatures for longer durations than EVLA. Maximum temperatures with three pulses per centimeter were significantly higher than with two pulses. RFA temperature rises were relatively mild, resulting in a plateau-shaped temperature profile, similar to EVSA. Temperature increase during EVLA is fast with a high-peak temperature for a short time, where EVSA and RFA have longer plateau phases and lower maximum temperatures.