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Zhang C, Lyu W, Qiu P, Zhang C, Zhao X, Wang X, He B, Fu B, Ji X. Laser ablation on vascular diseases: mechanisms and influencing factors. Lasers Med Sci 2023; 39:18. [PMID: 38155274 DOI: 10.1007/s10103-023-03964-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
Vascular diseases, such as venous insufficiency and coronary artery diseases, have been threatening the health of people. Efficient treatment with proper postoperative care is required to relieve the pain of the patients. Traditionally, venous insufficiency is treated with ligation and stripping, an open surgery whose complication rate cannot be ignored. Coronary artery disease is often treated with balloon angioplasty during which undilatable lesions may be encountered, limiting the efficacy of this approach. With advances in laser photonics and percutaneous coronary intervention procedure, laser ablation is emerging as an alternative and adjunctive therapy for these diseases. Endovenous laser ablation has the advantages of high success rate, low complication risk, and fast postoperative recovery. Laser ablation in arteries can handle uncrossable or undilatable lesions with a low incidence of serious complications. In this review, previously published research concerning vascular diseases and their therapies are analyzed in order to provide a clear explanation of the mechanisms and merits of laser ablation. For endovenous laser ablation, the main mechanisms are steam bubbles, heat conduction, and heat pipe, and three main influencing factors are wavelength, fiber types, and laser energy density. For excimer laser coronary atherectomy, the main mechanisms are photochemical, photothermal, and photomechanical effects, and three main influencing factors are catheter, medium, and laser parameters.
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Affiliation(s)
- Chenghong Zhang
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Wenhao Lyu
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Pengtianyu Qiu
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Congyu Zhang
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Xiaoli Zhao
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Xiaogang Wang
- Key Laboratory of Big Data-Based Precision Medicine Ministry of Industry and Information Technology, School of Engineering Medicine, Beihang University, Beijing, China
| | - Boqu He
- Key Laboratory of Big Data-Based Precision Medicine Ministry of Industry and Information Technology, School of Engineering Medicine, Beihang University, Beijing, China
| | - Bo Fu
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China.
- Key Laboratory of Big Data-Based Precision Medicine Ministry of Industry and Information Technology, School of Engineering Medicine, Beihang University, Beijing, China.
| | - Xunming Ji
- Neurosurgery Department of Xuanwu Hospital, Capital Medical University, Beijing, China.
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Safety, feasibility and early efficacy of the water-specific 1940 nm laser wavelength for ablation of saphenous incompetence. J Vasc Surg Cases Innov Tech 2023. [DOI: 10.1016/j.jvscit.2023.101125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Alozai T, Huizing E, Schreve MA, Mooij MC, van Vlijmen CJ, Wisselink W, Ünlü Ç. A systematic review and meta-analysis of treatment modalities for anterior accessory saphenous vein insufficiency. Phlebology 2021; 37:165-179. [PMID: 34965757 DOI: 10.1177/02683555211060998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate and compare the outcomes of the available treatment modalities for anterior accessory saphenous vein (AASV) incompetence. METHODS A systematic literature search was performed in MEDLINE, Embase, and the Cochrane Library. Studies reporting the outcomes of patients who were treated for primary AASV incompetence were included. The methodologic quality of the articles was assessed using the Methodological Index for Non-Randomized Studies (MINORS). A random-effects model was used to estimate anatomic success, defined as AASV occlusion. The secondary outcomes were pain during and after treatment, venous clinical severity score, quality of life, esthetic result, time to return to daily activities, and complications. RESULTS The search identified 860 articles, of which 16 met the inclusion criteria. A total of 609 AASVs were reported. The included studies were of poor or moderate quality according to MINORS score. The pooled anatomic success rates were 91.8% after endovenous laser ablation and radiofrequency ablation (EVLA, RFA, 11 studies), 93.6% after cyanoacrylate closure (3 studies), and 79.8% after sclerotherapy (2 studies). The non-pooled anatomic success rate was 97.9% after phlebectomy and 82% after CHIVA. Paresthesia was seen after EVLA in 0.7% of patients (6 studies). Phlebitis was seen in 2.6% of patients after RFA (2 studies), 27% after sclerotherapy (1 study), and 12% after the phlebectomy (1 study). Deep venous thrombosis and skin burn did not occur. CONCLUSION Treatment of AASV incompetence is safe and effective. Despite limited evidence, occlusion of the AASV can be achieved with endovenous thermal ablation and cyanoacrylate. There does not appear to be a benefit of EVLA compared to RFA regarding treatment efficacy. Phlebectomy shows promising results if the saphenofemoral junction is competent. Lower results are seen after sclerotherapy and CHIVA. However, studies with sufficient sample sizes of solely treatment of AASV incompetence are needed to draw firm conclusions.
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Affiliation(s)
- Tamana Alozai
- Department of Surgery, 1140Northwest Clinics, Alkmaar, The Netherlands
| | - Eline Huizing
- Department of Surgery, 1140Northwest Clinics, Alkmaar, The Netherlands
| | - Michiel A Schreve
- Department of Surgery, 1140Northwest Clinics, Alkmaar, The Netherlands
| | - Michael C Mooij
- Department of Phlebology, Skin and Vein Clinic Oosterwal, Alkmaar, The Netherlands
| | | | - Willem Wisselink
- Department of Vascular Surgery, 1209Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Çağdaş Ünlü
- Department of Surgery, 1140Northwest Clinics, Alkmaar, The Netherlands
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Cavallini A, Marcer D, Ferrari Ruffino S. Endovenous laser treatment of groin and popliteal varicose veins recurrence. Phlebology 2017; 33:195-205. [PMID: 28134021 DOI: 10.1177/0268355516687865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives Recurrent varicose veins following surgery is a common, complex and costly problem in vascular surgery. Treatment for RVV is technically more difficult to perform and patient satisfaction is poorer than after primary interventions. Nevertheless, traditional vein surgery has largely been replaced by percutaneous office-based procedures, and the patients with recurrent varicose veins have not benefited from the same advantages. In this paper, we propose an endovascular laser treatment that allows reducing the invasiveness and complications in case of SFJ and SPJ reflux after ligation and stripping of the great and small saphenous vein. Methods 8 SFJ and 1 SPJ stumps were treated by endovascular laser treatment in out-patient clinic. Endovascular laser treatment was performed with a 1470 nm diode laser and a 400 µc radial slim™ fiber. Intraoperative ultrasoud was used to guide the fiber position and the delivery of tumescent anesthesia. The gravity of chronic venous disease was determined according to the CEAP classification and the severity of symptoms was scored according to the revised Venous Clinical Severity Score (VCSS). Results The average linear endovenous energy density was 237 J/cm. Patients return to daily activities after a mean of 1.9 days after. The VCSS improved drastically from a mean of 8 pre-interventional to 1 at day 30 and until one year. During the follow-up period (mean 8 months, range: 5-17 months), all the stumps except one were occluded. All patients were very satisfied or satisfied with the method. No severe complications occurred. Conclusions Office-based endovascular laser treatment of groin and popliteal recurrent varicose veins with 1470 nm diode laser and radial-slim fiber is a safe and highly effective option, with a high success rate in the early post-operative period.
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Cowpland CA, Cleese AL, Whiteley MS. Factors affecting optimal linear endovenous energy density for endovenous laser ablation in incompetent lower limb truncal veins – A review of the clinical evidence. Phlebology 2016; 32:299-306. [DOI: 10.1177/0268355516648067] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The objective is to identify the factors that affect the optimal linear endovenous energy density (LEED) to ablate incompetent truncal veins. Methods We performed a literature review of clinical studies, which reported truncal vein ablation rates and LEED. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow diagram documents the search strategy. We analysed 13 clinical papers which fulfilled the criteria to be able to compare results of great saphenous vein occlusion as defined by venous duplex ultrasound, with the LEED used in the treatment. Results Evidence suggests that the optimal LEED for endovenous laser ablation of the great saphenous vein is >80 J/cm and <100 J/cm in terms of optimal closure rates with minimal side-effects and complications. Longer wavelengths targeting water might have a lower optimal LEED. A LEED <60 J/cm has reduced efficacy regardless of wavelength. The optimal LEED may vary with vein diameter and may be reduced by using specially shaped fibre tips. Laser delivery technique and type as well as the duration time of energy delivery appear to play a role in determining LEED. Conclusion The optimal LEED to ablate an incompetent great saphenous vein appears to be >80 J/cm and <95 J/cm based on current evidence for shorter wavelength lasers. There is evidence that longer wavelength lasers may be effective at LEEDs of <85 J/cm.
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Affiliation(s)
| | | | - Mark S Whiteley
- The Whiteley Clinic, Stirling House, UK
- Faculty of Health and Biomedical Sciences, University of Surrey, UK
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Wilson CR, Hardy LA, Kennedy JD, Irby PB, Fried NM. Miniature ball-tip optical fibers for use in thulium fiber laser ablation of kidney stones. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:18003. [PMID: 26784588 DOI: 10.1117/1.jbo.21.1.018003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/08/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Christopher R Wilson
- University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Boulevard, Charlotte, North Carolina 28223, United States
| | - Luke A Hardy
- University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Boulevard, Charlotte, North Carolina 28223, United States
| | - Joshua D Kennedy
- University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Boulevard, Charlotte, North Carolina 28223, United States
| | - Pierce B Irby
- Carolinas Medical Center, McKay Department of Urology, 1023 Edgehill Road South, Charlotte, North Carolina 28207, United States
| | - Nathaniel M Fried
- University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Boulevard, Charlotte, North Carolina 28223, United StatesbCarolinas Medical Center, McKay Department of Urology, 1023 Edgehill Road South, Charlotte
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van Eekeren RR, Boersma D, de Vries JPP, Zeebregts CJ, Reijnen MM. Update of endovenous treatment modalities for insufficient saphenous veins—A review of literature. Semin Vasc Surg 2014; 27:118-36. [DOI: 10.1053/j.semvascsurg.2015.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Endovenous Laser Ablation of Great Saphenous Veins Performed Using Tumescent Cold Saline Solution without Local Anesthesia. Ann Vasc Surg 2014; 28:951-6. [DOI: 10.1016/j.avsg.2013.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 10/13/2013] [Accepted: 11/19/2013] [Indexed: 11/21/2022]
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