Endovenous laser ablation: mechanism of action
- 1 October 2008
- journal article
- review article
- Published by SAGE Publications in Phlebology: The Journal of Venous Disease
- Vol. 23 (5), 206-213
- https://doi.org/10.1258/phleb.2008.008049
Abstract
Objectives The objective of this study is to review the basics of laser and established tissue response patterns to thermal injury, with specific reference to endovenous laser ablation (EVLA). This study also reviews the current theories and supporting aspects for the mechanism of action of EVLA in the treatment of superficial venous reflux. Methods The method involves the review of published literature and original investigation of histological effects of 810 nm and 980 nm wavelength EVLA on explanted blood-filled bovine saphenous vein in an in vitro system. Results The existing histological reports confirm that EVLA produces a transmural vein wall injury, typically associated with perforations and carbonization. The pattern of injury is eccentrically distributed, with maximum injury occurring along the path of laser contact. Intravenous temperature monitoring studies during EVLA have confirmed that the peak temperatures at the fibre tip exceed 1000°C, and continuous temperatures of at least 300°C are maintained in the firing zone for the majority of the procedure. Steam production during EVLA, which occurs early in the photothermolytic process when temperatures reach 100°C, accounts for only 2% of applied energy dose, and is therefore unlikely to be the primary mechanism of action of thermal injury during the procedure. Conclusion EVLA causes permanent vein closure through a high-temperature photothermolytic process at the point of contact between the vein and the laser.Keywords
This publication has 19 references indexed in Scilit:
- Endovenous Laser Treatment of Saphenous Vein Reflux: How Much Energy Do We Need to Prevent Recanalizations?Vascular and Endovascular Surgery, 2008
- Factors Influencing the Effectiveness of Endovenous Laser Ablation (EVLA) in the Treatment of Great Saphenous Vein RefluxEuropean Journal of Vascular and Endovascular Surgery, 2008
- Reduced recanalization rates of the great saphenous vein after endovenous laser treatment with increased energy dosing: Definition of a threshold for the endovenous fluence equivalentJournal of Vascular Surgery, 2006
- Endovenous Laser Ablation of the Great Saphenous Vein with a 980-nm Diode Laser in Continuous Mode: Early Treatment Failures and Successful Repeat TreatmentsJournal of Vascular and Interventional Radiology, 2006
- Endovenous Ablation of Incompetent Saphenous Veins:A Large Single-Center ExperienceJournal of Endovascular Therapy, 2006
- Intravascular lasers in the treatment of varicose veinsJournal of Cosmetic Dermatology, 2004
- Endovenous Laser Surgery of the Incompetent Greater Saphenous Vein With a 980-nm Diode LaserDermatologic Surgery, 2003
- Natural History of Venous ThromboembolismCirculation, 2003
- Comparison of Endovenous Radiofrequency Versus 810 nm Diode Laser Occlusion of Large Veins in an Animal ModelDermatologic Surgery, 2002
- Optical Properties of Circulating Human Blood in the Wavelength Range 400–2500 nmJournal of Biomedical Optics, 1999