Standardisation of Parameters during Endovenous Laser Therapy of Truncal Varicose Veins - Experimental Ex-vivo Study

BackgroundVein shrinkage is a surrogate marker for successful laser treatment of varicose veins. However, many controversies still remain concerning the best laser parameters to use. The aim of this study was standardisation of intraoperative energy dosages and pull-back rates to achieve optimal clinical results.DesignEx-vivo study in surgically removed saphenous trunks.Material and methodsGreat saphenous veins were removed by Babcock stripping and irradiated with laser energy delivered by a laser diode emitting at 980 nm. In total, 279 vein segments (5 cm long) were treated using powers from 5–15 W. Vein segments were opened longitudinally and the circumference measured in the treated and untreated regions to assess thermal shrinkage.ResultsThe greatest shrinkage and minimum number of perforations was achieved using lower or medium power (8 to 12 W) with longer exposure to administer laser energy. The median percentage vein shrinkage was 50% (power 5 W), 45% (8 W), 40% (10 W), 45% (12 W) and 59% (15 W). When a higher power was used (15 W), the perforations were more frequent and carbonisation was marked.ConclusionsOur data suggests that similar efficacy with fewer vein perforations may be obtained with low or medium power settings and increased exposure when undertaking laser obliteration of saphenous trunks. This may result in fewer adverse events such as ecchymosis following treatment in patients.