but prior to giving off incompetent tributaries in the

lower Jeg. The skin is anesthetized with lidocaine andthe GSV is punctured under sonographic guidance. A5-Fr, 45-cm-long introducer sheath is placed into theGSVover a 0.035-inch diameter J guidewire. Intraluminalposition within the GSV is confirmed by aspiration af

non-pulsatile venous blood and visualization with ultra­sound.

Asterile, bare-tipped 600-micron-diameter laser fiber(Diomed, Andover, MA) is introduced into the veinthrough the sheath. The distal tip of the Jaser fiber ispositioned at the SFJ using sonographic guidance andconfirmed by direct visualization of the red aiming beamof the laser fiber through the skin.

Perivenous local anesthesia (l00-200 mI of 0.25%lidocaine) is administered along the GSV using sono­graphic guidance. Proper administration of an adequateof amount fluid around the vein will provide both com­pression of the vein around the catheter/laser fiber inorder to ensure circumferential heating of the vein wall,and a protective "heat sink."

810 nm of diode laser energy is provided by theDiomed DIS Surgical Laser (Diomed, Inc., Andover,MA). Energy is delivered endovenously 5-10 mm belowthe SFJ and along the course of thę GSV as the laser fiberis slowly withdrawn at a rate of 3 to 5 mm/sec. Thefollowing parameters are used: 14 watts, cantinuousmode.

Class II (30-40 mm Hg) graduated compressionstockings are wom for one week following treatrnenŁ.

Patients are instructed to walk immediately folIowing theprocedure and to continue their normaI daily activitieswith the exception of vigorous gym workouts.

Ambulatory phlebectomy can be performed folIow­ing endovenous laser, or altematively, the tributaries canbe treated with compression sclerotherapy, beginning 4weeks after endovenous laser treatmenŁ.

Results• 297/305 (97%) of GSVs successfully c10sed folIow­

ing initial endovenous laser treatment• 298/304 (98%) af GSVs remain closed at 3-30

month follow-up• Well talerated by all patients under strictly local

anesthesia• Patients may experience slight bruising and mild to

moderate discomfort (described as a "pulling" sen­satian) alang the treated GSV, starting 5-7 dayspost-EVLT and resolving in 3-5 days

• There have been no skin bums, paresthesias,DVTs, or other adverse reactions

Conclusłons

Compared with existing minimally invasive endavenaustecbniques such as transeatheter sclerotherapy ar radia­frequency ablatian, endovenaus laser has the follawingpatential advantages:

• Transmissian af energy through a smali diameter,

flexible fiber allaws minimaI access site size, andtreatment af a wider variety and size af veins.

• Faster rates af withdrawal and shallaw depth ofpenetration af laser energy may resuIt in less dam­age to surrounding non-target tissue compared toradiofrequency.

• Lower disposable treatment costs compared withradiofrequency catheter abJation.

• Patients with pacemakers are not excluded fromtreatrnenŁ.

• Avaidance of the risk of intra-arterial injection andminimal risk af anaphylaxis compared with ultra­saund-guided sclerotherapy.

• Precise cantral af vein wall damage may lead tolower rates af recanalization compared to chemicalclosure Cie, sclerotherapy).

The combined experience with endavenaus lasertreatment of varicose veins has been extremely favar­able, with very effective occlusian of incompetent GSVsegments (5,6). We await longer-term follow-up resultsfrom patients already treated with endovenaus laser andadditianal evaluatian af this promising new technique,which appears to affer a gaod alternative to ligatian andstripping for thase patients wishing to avoid surgery.

References1. Sarin S. Scurr JH, Caleridge Smith PD. Assessment of

stripping of the long saphenous vein in the treatrnentaf primaly varicose veins. BrJ Surg 1992; 79:889-893.

2. Dwerryhouse S, Davies B, Hanadine K, Earnshaw JJ.Strippin the long saphenaus vein reduces the rate ofreaperation for recurrent varicase veins: five yearresuIts af a randamized trial. J Vasc Surg 1999; 29:589-592.

3. Min RJ. Navarro L. Transcatheter duplex ultrasound­guided sclerotherapy for treatment af greater saphe­naus vein reflux: preliminary report. Dermatol Surg2000; 26:410-414.

4. Manfrini S, et al. Endavenaus management of saphe­naus vein reflux. J Vasc Surg 2000; 32:330-342.

5. Min Rj. Endavenaus laser treatment of the incompe­tent greater saphenous vein. J Vasc Interv Radiol2001; 12:1167-1171.

6. Navarro L, Min R, Bane C. Endovenaus laser: a newminimally invasive method af treatrnent for varicoseveins: preliminary observations using an 810 diodeJaser. Dermatol Surg 2001; 27:117-22.

3:35 p.m.

Q&A

3:55 p.m.

BreakP13