[The endovenous laser therapy of varicose veins--substantial innovation or expensive playing?]. / Die endovenöse Lasertherapie der Varicosis--echte Innovation oder teure Spielerei?

INTRODUCTION: The aim of the study was to evaluate the efficiency of the endovenous use of laser for treatment of varicose veins. In particular the influence of laser energy on the perivenous temperature, the postoperative clinical and duplex ultrasound course was taken into account. METHOD: The patients were divided into two groups. In 33 cases the laser therapy was used without perivenous liquid protection. In 30 cases a 0.9 % NaCl solution has been injected around the vein. The laser used was a 980 nm diode laser (Ceralas D 980, Biolitec AG, Bonn). The pulse-mode procedure has been applied for triggering the laser impulse (1.5 s pulse length, 1.5 s pause with a 3 mm withdrawal of the laser fibre. The laser energy was 15 watt. 20 cm distal to the saphenofemoral or saphenopopliteal junction a thermo unit measured continuously the perivenous temperature. Clinical and duplex ultrasound checks were carried out before and on the day of the operation. Further checks followed on the first and tenth day after the operation and 8 weeks and 6 months afterwards. RESULTS: The perivenous temperature prior to ELT was 31.3 degrees C, then dropping after the injection of the NaCl solution by 3.4 degrees C. During the ELT the temperature rose by 10.0 degrees C without and by 5.5 degrees C with infiltration. The rise in temperature happened only 3 cm before the tip of the laser fibre arrived at the thermo unit and fell quite rapidly. 98 % of the veins showed within the time period of 2 to 14 months an effective occlusion controlled by duplex ultrasound without refluxing segments. All operations were out-patient treatments. The patients were able to take up work after 1 to 7 days. CONCLUSION: The endovenous laser treatment is an innovative method for the treatment of varicose veins. Considering the mid-term subjective and objective outcomes this method can not only compete with the conventional surgery but has proved to be superior as regards the recurrence rate and patient's comfort. The study presented here, did not find a risk of damage to surrounding non-target tissue.

Atherectomy tools for arterial treatment.

When considering limb salvage in patients with failed bypass or angioplasty, the threshold for cost effective use of atherectomy devices is important. Rotational ablation, in these cases, has offered a significant contribution to patient care. Decreased hospital stay, morbidity and mortality, plus improved quality of life are all factors in the calculation. Interventional radiologists, vascular surgeons and interventional cardiologists aim to maintain function, not to perfectly restore original anatomy. In this respect, percutaneous rotational ablation has a role as a useful device when indicated. Indications should include consideration of the pattern of disease and underlying pathology as much as the site and selection of the lesion. The Rotablator may be the device of choice in many coronary cases and it is an important device in planning peripheral revascularization procedures. It provides an option for patients and physicians who wish to achieve minimal invasion with the best possible results.

Lasers in cardiovascular medicine.

The role of lasers in cardiovascular medicine and surgery is a rapidly evolving and uncertain field. Many alternative percutaneous techniques and technologies for removal of atherosclerotic plaque are under development. However, according to many clinicians, atherectomy devices that bore through occlusions with high speed burrs, shave them away with miniature knives, or micropulverize them with ultrasonic waves will be complements not substitutes to both lasers and balloons. Thus, it is unlikely that a cost-effective substitute for the laser is likely to come from developments in mechanical ablation systems. It is important to keep in mind that peripheral laser angioplasty is still considered of benefit to a small percentage of all candidates for peripheral percutaneous transluminal angioplasty, and that coronary laser angioplasty is strictly investigational. Although more devices may be approved in the next year, only two are available on the open market at publication, and both are approved only for peripheral angioplasty. With the rapid growth in the number of laser manufacturers entering the market, there are ample opportunities for large hospitals with active cardiology and cardiovascular surgery programs to become trial sites. However, the smaller hospital set on entering the market may want to consider only well-established, FDA approved technologies that are reasonably priced.