MedArt – ILVO
- Fast outpatient procedure
- No Post-op downtime
- In-built power meter
- Continuous or pulsed mode
- New 1470nm output
- Compact and cost-effective
Intra-lumenal Laser Vein Occlusion
Varicose veins pose a problem to approx. 15-30% of the adult population, increasing with age. The majority are females where the problem typically arises after giving birth.
Superficial varicose veins in the leg are due to incompetence of the saphenofemoral junction (SFJ) and the greater saphenous vein (GSV). The valves in these veins have become ineffective thus resulting in the dilation and reversal of blood flow and blood stasis. The condition is to a large extent cosmetic, however with a certain degree of discomfort, and in a few cases it poses risk of ulcer development or inflammation, if not treated.
There are various treatment methods to remove varicosities. One of the most common is surgical ligation and stripping, where the vein is removed from the leg through various small incisions along the GSV. Even though the method is efficient, it requires considerable patient downtime and discomfort and often has to be done in general anesthesia.
A new minimally invasive method, approved by the FDA, has been developed to reduce patient downtime and discomfort: Intraluminal Laser Vein Occlusion.
Even though the treatment method is still fairly new, a number of scientific papers have evaluated the treatment results as close to 100% closure after approx. One year follow-up, with a substantial loss in GSV diametre. Some of the earliest studies present a 28 month follow-up time with positive results but a higher degree of unwanted side-effects, probably due to the technique still needing refinement at the time of treatment.
These results clearly match those of surgical treatments. Further clinical analysis is still needed to confirm these results.
Materials and method
An 810 nm laser with a minimum of 15 W output power is used. Alternatively, a 980 nm laser can be used also with 15 W minimum output power. A 600 micron optical fibre is needed together with a guide wire introducer sheath and needle for percutaneous perforation.
Prior to treatment the SFJ and GSV are mapped through use of colour duplex ultrasound.
The guide wire introducer sheath is introduced into the GSV – at level with the knee or the lower part of the thigh. The fibre is advanced via the introducer sheath until the fibre tip is positioned 1-2 cm distal to the SFJ. A red guiding light emitted from the fibre tip provides a helpful indication of the tip position. Prior to release of the laser beam, the exact tip position is controlled carefully by use of ultrasound.
When laser is delivered by the introduced fibre, heating of the blood leads to formation of a steam bubble. That is, the effect of the laser is not achieved through contact with the wall of the blood vessel, but rather by creating a local high energy steam bubble.
Heat emitted from the bubble causes thermal injury to the endothelium and vein wall extending to the adventitia. Consequently this will cause the vein wall to collapse and occlusion is achieved. As soon as the laser is turned off, the steam bubble immediately collapses ensuring a very localised damage to the tissue.
The recommended laser treatment settings for the procedure are:
10-14 W continuous wave output power, laser energy bursts of 1 second equalling an energy of 10-14J.
The method has been well tolerated by the majority of the patients treated, with only occasional feelings of heat during treatment. Most patients show mild ecchymosis and occasional mild induration and paresthesia in the area of anesthetic infiltration. There have been extremely few cases of skin burns and inflammation. It is expected that the undesired side-effect incidence will decrease as the operators gain more experience in the use of this new technique.