Clinical Study On Endovenous Treatment Of Lower Extremity Varicose Vein With A 940nm Diode Laser

Objective To evaluated the safety and efficacy of endovenous 940nm diode laser treatment(EVLT) for lower extremity varicose vein, treatment-related side effects, and preliminary mechanisms of action.Methods One hundred thirty-one patients (209 limbs)of clinical stages C_2-6 with varicose vein was treated by EVLT. The distal tip of the laser fiber was positioned 1-2 cm below the saphenofemoral junction with duplex ultrasound scanning control during EVLT. Some great saphenous vein that was surgically removed after EVLT was examined by means of histopathology.Duplex ultrasound scanning was performed at 1,3,6,9 months after the operation. A comparison was made between EVLT and traditional surgery(great saphenous vein high ligation and stripping).Results The hospital stay and operation duration was significant less in EVLT group than traditional surgery group.The treatment-related side effects (deep venous thrombosis, ecchymoma, incision numbness, incision healing bad)was significant less in EVLT group than traditional surgery group. The quantity of incision was significant less in EVLT group than traditional surgery group. The average length of incision was significant shorter in EVLT group than traditional surgery group.The effect of two groups on improving the symptoms were not different. Histopathologic examination found the vein wall treated by EVLT showed reddening, carbonization, or even perforation, denudation of the intima, loss of cellular contours,and fibrin deposition. Additionally, some areas show marked vacuolization of cells or even spongiosis,swelling and waxy homogenization of collagen, focal coagulation necrosis within the intima.But the normal varicose vein after stripping without earlier EVLT with intact endothelium and distinct cellular contours. The nuclei are round to oval.Conclusion 940nm diode laser induced indirect local heat injury of the inner vein wall by steam bubbles originating from boiling blood is proposed as the pathophysiological mechanism of action of EVLT.The short term efficacy of EVLT is definite with insignificant side-effect, and quick patient recovery.