RGV Vein Laser and Aesthetic Clinic, Brownsville, TX.The Body Sculpting Center, Scottsdale, AZ.

Optimal Energy Delivery Dose for Successful Saphenous

Endovenous Laser Ablation Using the 1470-nm Diode

LaserFiliberto Rodriguez MD,

Margaret Clark RN, Thomas A Clark MD

Endovenous laser ablation (EVLA) is well established for treatment of saphenous vein reflux

Traditional 810 to 980-nm wavelengths have been associated with:- Post-procedure paresthesia- Pain - Ecchymosis

Introduction

Newer wavelengths (1330-nm and 1470-nm) hold potential for successful EVLA with decreased pain both during and after the procedure

Literature is conflicting, with high energy settings for the 1470-nm laser (7-15W) and comparing results using bare-tipped versus radial emitting fibers

Introduction

Quantify the optimal energy delivery dose for EVLA with the 1470-nm laser

Compare efficacy outcomes and post-procedure pain with the 810-nm laser

using bare-tipped fibers for both

Purpose

Understanding Wavelength Targets

De Felice Phlebology.2010; 25: 11-28

810-nm 1470-nm

1470-nm laser associated with decreased energy requirement for

EVLA, which may translate into decreased post-procedure pain

Hypothesis

A retrospective chart review was performed from August 2009, when we first began using the 1470-nm laser, through May 2010 (10 months)

The 1470-nm laser was utilized in one clinic while the 810-nm laser was used simultaneously in a second location

Methods

All EVLA procedures were performed- in an outpatient setting- in a sterile manner- via Seldinger technique- under local tumescent

anesthesia- using bare-tipped laser fibers

Methods

Ultrasound guidance utilized: - vascular access

Methods

Methods

Methods

Endoluminal Opacification

Wattage settings for the Diomed 810-nm laser were consistent: – 14W for all GSV EVLAs

– 12W for all SSV EVLAs

Wattage settings for the ThermaLite™ 1470-nm– Initially set at 6W for all GSV EVLAs

– adjusted as our experience grew

Methods

Measurements were recorded for:- vein segment lengths

- diameter

- laser wattage setting

- total joules delivered

- post-procedure pain (0-5 scale, post-op day 1)

Methods

Results

r = 0.526284, p<0.05

Results

Successful EVLA was similar (99.6% vs. 100%), with one failure during the early adoption of the 1470-nm laser - energy delivery dose was only 16J/cm

- successfully treated with repeat 1470-nm EVLA (38.8J/cm)

Results

Trend towards decreased post-procedure pain with the 1470-nm laser (1.08/5 vs. 1.33/5), although this failed to reach statistical significance- Possible Type-II statistical error

- limited sample size with unequal numbers

- qualitative measure of post-procedure pain at a single time-point (post-procedure day 1)

Anecdotal experience is that the 1470-nm is better tolerated than the 810-nm laser both during the procedure and after

Results

Conclusions

The 1470-nm laser can be used for successful EVLA with significantly less energy compared with the 810-nm laser

This decreased energy may translate into decreased pain during and after EVLA

An energy delivery dose of only 25-30 J/cm ensures therapeutic success with the new 1470-nm wavelength

The wattage setting of 4-5 W is determined in correlation with the vessel diameter

Thank You