Endovenous laser ablation of great saphenous veins using a 1470 nm diode laser and the radial fibre--follow-up after six months.

BACKGROUND: Endovenous laser ablation (EVLA) is an efficient method to treat insufficient great saphenous veins (GSV) with high occlusion rates. Most studies used 810, 940 or 980 nm diode lasers and a bare fibre. Moderate postoperative pain and bruising are frequent findings. Laser systems with higher wavelengths like 1470 nm with a higher absorption in water show less pain and bruising after the procedure. A newly-developed fibre (radial fibre, Biolitec) emits the laser energy radially around the tip directly into the venous wall contrary to the bare fibre.(9) The aim of this study was to demonstrate the outcome and side-effects after EVLA of GSV with a 1470 nm diode laser (Ceralas E, Biolitec) by using the radial fibre. METHODS: Non-randomized, prospective study including 50 unselected limbs of 50 patients with a duplex sonographically verified incompetent GSV. EVLA was performed with a 1470 nm diode laser (Ceralas E, Biolitec) and a radial fibre. In the same session all insufficient tributaries were treated by phlebectomy. Tumescent local anaesthesia with 0.05% lidocaine was applied perivenously. Laser treatment was carried out in a continuous mode with a power of 15 W. Compression stockings (30 mmHg) were applied for one month. Postinterventional checkups took place one, 10, 30 days and six months after the procedure. RESULTS: Three patients were lost to follow-up. The average linear endovenous energy density (LEED) was 90.8 J/cm vein (SD 35.3). At the six month follow-up all treated veins remained occluded and no new reflux in the treated segments occurred. No recurrent varicose veins had occurred so far. No severe complications such as deep venous thrombosis could be detected. In four patients at 30 days and three patients at six months local paresthesia occurred in the region of EVLA. Forty-four percent of patients did not have any pain after the treatment and 50% did not take any analgesic tablets at any time after the procedure. Postoperative ecchymoses in the track of the treated GSV was rare. In 80% of the limbs, no ecchymoses was observed after the treatment. CONCLUSION: EVLA of GSV with a radially emitting laser fibre by using a 1470 nm diode laser is a safe and efficient treatment option.

1470 nm diode laser for endovenous ablation (EVLA) of incompetent saphenous veins - a prospective randomized pilot study comparing warm and cold tumescence anaesthesia.

BACKGROUND: 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. PATIENTS AND METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Does laser power influence the results of endovenous laser ablation (EVLA) of incompetent saphenous veins with the 1 470-nm diode laser? A prospective randomized study comparing 15 and 25 W.

AIM: Major side effects after endovenous laser ablation (EVLA) are pain and bruising. The aim of this study was to compare outcome and side effects after EVLA of incompetent great saphenous veins (GSV) with a 1 470 nm diode laser (Ceralas E, biolitec) using a power of 15 or 25 W. METHODS: Between 28 November 2007 and 15 January 2008, 40 consecutive patients (40 legs) with an incompetent GSV were treated by EVLA. The patients were randomized in two groups. In Group A (20 patients) was used a 15-W-power laser and in Group B (20 patients) a 25-W-power laser was used. All patients were re-examined after 1, 10 and 30 days clinically and by Duplex for complications and occlusion in the treated vein segment in a standardized way. RESULTS: There was no significant difference concerning gender, age, C of CEAP, body mass index or diameter of the treated vein. In Group A a mean of 465 mL tumescence fluid (TF) was used and in Group B TF was of 433 mL. In Group A the mean linear endovenous energy density (LEED) was 109.7 J/cm and in Group B 132.6 J/cm. The subgroup Bsub included 16 patients of Group B with a comparable mean LEED of 115.8 J/cm. In all groups occlusion of the treated veins was achieved for all patients. The diameter of the GSV reduced at 3 cm below the sapheno-femoral junction from 1.1 to 0.6 cm, 1.0 to 0.6 cm and 0.9 to 0.6 cm respectively in the three groups. The modified CEAP clinical score improved significantly in all groups. In Group A patients have been administered analgesic tablets for a shorter period. There was also a trend to less postinterventional pain and analgesic use in Group A, but it was not significant. Ecchymosis was rare in both groups (8 in Group A, 7 in Group B). CONCLUSIONS: In this prospective randomized comparative study the power of the laser did not influence the occlusion rate when a high LEED with comparable values was used. In both groups pain and ecchymoses were less frequent in this study with a 1 470 nm diode laser than reported in studies with 810-980 nm systems. A lower power level significantly reduced use of analgesic tablets.

First results with a new 1470-nm diode laser for endovenous ablation of incompetent saphenous veins.

INTRODUCTION: Most of the published EVLA data concern 810, 940, 980 nm diode lasers and 1064 or 1320 nm Nd:Yag laser systems. Major side effects are postoperative pain and bruising. The aim of this study was to show the outcome one year after EVLA of incompetent saphenous veins with a 1470 nm Diode laser (Ceralas E, biolitec). PATIENTS AND METHOD: Between December 2006 and February 2007, 134 saphenous veins (108 GSV, 26 SSV) in 117 legs of 100 consecutive patients where treated by EVLA for GSV and SSV incompetence. All patients were examined clinically and with duplex by an experienced phlebologist prior to intervention, and at the follow-up visits for complications, occlusion, flow and reflux in the treated vein segment. The clinical evaluation included clinical CEAP and the presence of recurrent varicose veins. Patient satisfaction was assessed by a 0 to 4 scale. RESULTS: After a mean follow-up period of 184 days (SD 27) 127 treated veins (102 GSV, 25 SSV) of 111 limbs in 94 patients and after 329 days (SD 14) 105 treated veins (94 GSV, 21 SSV) of 105 limbs in 83 patients were reinvestigated. Six patients were lost to follow up after six months and an additional 11 patients after one year. Up to one year follow-up all treated veins remained occluded. At six months, one new insufficient anterior accessory saphenous vein (AASV) and after 12 months, three new insufficient AASV occurred. After one year 45 patients were very satisfied with the method, 34 were satisfied, three were fairly and one was not satisfied. The mean of all answers was 0.5 (SD 0.5). In three cases phlebitic reactions after 10 days, but no severe complications such as deep vein thrombosis occured. After six months in 9.5% of the legs paresthesia was present in the treated area which reduced to 7.6% after one year. Intake of painkillers was mean 6.7 tablets (SD 3.5). When we compared GSV legs treated with LEED below or above 100 J/cm, the paresthesia rate was significantly lower in the first group with 2.3% compared to 15.5 % in the higher LEED group. The differences for number of days with analgesic intake and for the paraesthetic area were significant. Discussion In this prospective follow-up study with 100 consecutive patients and 134 treated saphenous veins a high occlusion rate of 100% could be demonstrated one year after treatment. However, with LEED > 100 J/cm in this study, the incidence of paresthesia rose significantly. Therefore it seems adequate to stay below 100 J/cm in the future as the occlusion rate was the same below and above 100 J/cm. CONCLUSION: EVLA of GSV and SSV with a 1470 nm diode laser is a minimally invasive, safe and efficient therapy option with a high success rate.

[Severe acute pancreatitis: role for laparoscopic surgery]. / Die Rolle der laparoskopischen Chirurgie bei schwerer akuter Pankreatitis.

UNLABELLED: Minimally invasive surgery is a new and promising treatment modality in the management of patients with severe acute pancreatitis (SAP). Aim of our study was the evaluation of our first experiences with laparoscopic surgery in the management of patients with SAP. METHODS: A total of 65 patients complied with Atlanta recommendations for SAP and were included into this retrospective study. Indications for laparoscopic surgery were SAP presented with intraabdominal or retroperitoneal exudates and detected by ultrasound (US) and/or contrast enhanced computer tomography (CT) scan, and the presence of acute calculous cholecystitis when 3 to 5 days of conservative treatment did not show clinical improvement and surgical treatment was considered. Patients with improvement after initial therapy received conservative therapy only. Bacteriological cultures were done for abdominal exudates and necrotic tissue obtained during surgery. RESULTS: Totally, 39 patients were operated and 26 were treated conservatively only. Laparoscopic surgery was started in 31 patients and completed in 26 patients. The overall conversion rate was 16.1 %. Laparoscopic drainage of the intraabdominal exudate was done in 26 patients including drainage of the lesser sac in five of them. Laparoscopic cholecystectomy in 25 cases and laparoscopically assisted jejunostomy in 6 cases were performed as a part of the procedure. Conventional surgery was the primary procedure in 8 patients. Peripancreatic abscess formation was observed in one case one month after laparoscopic procedure and was cured with conventional surgical drainage. Bile leakage from the cystic stump was successfully treated with endoscopic papillotomy in one case. All patients survived after laparoscopic procedures. Overall complication rate was 7.7 % and mortality reached 3.1 %. CONCLUSIONS: Laparoscopic drainage of the abdominal cavity, drainage of the lesser sac and revision of the retroperitoneal compartment can be safely carried out as an alternative to the conventional surgical approach. Laparoscopic cholecystectomy and/or jejunostomy may be additionally performed if indicated.