Fiber type as compared to wavelength may contribute more to improving postoperative recovery following endovenous laser ablation

ObjectiveTo define the relative importance of fiber type as compared to laser wavelength on tissue injury depth, postoperative pain, and bruising during endovenous laser ablation.MethodsThis study included 213 limbs that were treated with an 810-, 980-, or 1470-nm laser, with bare-tip (BT) or jacket-tip (JT) fibers. Pain scores (10-point scale) and bruising scores (5-point scale) were recorded. Tissue thermal injury depth (mm) was evaluated in vitro for the 810- and 1470-nm wavelengths with BT and JT fibers.ResultsThe JT fibers had lower pain scores as compared to the BT fibers at 810 nm (1.69 ± 1.77 vs 3.70 ± 1.34; P < .0005) and at 980 nm (1.14 ± 1.06 vs 2.71 ± 1.80; P < .0005). The JT fibers had lower bruising scores as compared to the BT fibers at 980 nm (0.89 ± 1.06 vs 2.00 ± 1.44; P < .0005). The in vitro study showed lower thermal injury depths for the JT as compared to the BT fibers at 810 nm (0.36 mm ± 0.26 mm vs 1.05 mm ± 0.34 mm; P < .0005) and at 1470 nm (0.20 ± 0.16 mm vs 0.71 ± 0.31 mm; P < .0005). With regard to wavelength, 980-nm laser had lower pain scores as compared to 810-nm laser with BT fibers (2.71 ± 1.80 vs 3.70 ± 1.34; P = .015), and with JT fibers, a similar result trended toward significance (1.14 ± 1.06 vs 1.69 ± 1.77; P = .057). The 980-nm JT fiber showed less bruising as compared to the 810-nm JT fiber (0.89 ± 1.06 vs 1.42 ± 1.19; P = .019). Similarly, the 1470-nm JT fiber showed less bruising as compared to the 810-nm JT fiber (0.94 ± 1.02 vs 1.42 ± 1.19; P = .038). The in vitro study showed thermal injury depths that were less for 1470 nm as compared to 810 nm, with JT fibers (0.20 ± 0.16 mm vs 0.36 ± 0.26 mm; P = .013) or with BT fibers (0.71 ± 0.31 mm vs 1.05 ± 0.34 mm; P =.001). All mean differences between JT and BT fibers were greater than between differing wavelengths. The multivariate analysis for the in vitro study showed a mean difference between 1470 nm and 810 nm of 0.26 mm, P < .0005 favoring 1470 nm and a mean difference between JT and BT fibers of 0.61 mm, P < .0005 favoring the JT fibers.ConclusionsThe use of a JT fiber appeared to be more significant in reducing pain and bruising as compared to a longer wavelength. Moreover, the results appeared additive, and the cohort using 1470 nm with a JT fiber produced the best treatment outcomes. Additional study is required to confirm the efficacy and durability of the various iterations evaluated; however, these data should be taken into consideration when undertaking treatment with endovenous laser ablation.