What is the role of endovenous laser therapy in the treatment of varicose veins and spider veins (telangiectasia)?

Updated: Feb 28, 2018
  • Author: Robert Weiss, MD; Chief Editor: William D James, MD  more...
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Answer

Endovenous laser therapy is a thermal ablation technique that uses a laser fiber placed inside the vein. [16]

Seldinger over-the-wire technique is used to place a long catheter along the entire length of the truncal varix to be ablated. A bare laser fiber is passed through the catheter until the end protrudes from the tip of the catheter by about 2 cm and the laser fiber tip is positioned at the saphenofemoral junction just distal to the subterminal valve. The position is confirmed by ultrasonography and by use of the laser guide light.

Under ultrasonographic guidance, very dilute, high volume local tumescent anesthetic is injected around the vessel to be ablated until a halo of tumescence is observed along the entire length of the vessel, separating it from its fascial sheath.

Firm pressure is applied to collapse the vein around the laser fiber, and the laser is fired with settings sufficient to cause irreversible thermal endothelial damage.

The laser may be set for continuous delivery of energy, in which case the fiber and catheter must be withdrawn at a slow and constant rate, or for intermittent pulses, in which case the fiber and catheter are withdrawn about 2 mm after each pulse and the process is repeated along the entire course of the vessel.

One system, using a 1320-nm laser, uses an automatic pullback mechanism.


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