Search Results (14)

Lasers are increasingly used in the biomedical field because of their concentrated energy, good stability, ease of use, and other advantages, promoting the development of precision medicine to a higher level. Medical laser equipment has transformed from a single therapeutic tool in an intelligent and precise diagnostic system. Existing clinical laser equipment has significant technical bottlenecks regarding soft-tissue ablation precision and multimodal diagnostic compatibility, which seriously restricts its clinical application. High-power thulium-doped fiber lasers with operating wavelengths of 1.9–2.1 μm provide a revolutionary solution for minimally invasive surgery due to their high compatibility with the absorption peaks of water molecules in biological tissues. This study reviews recent advances in high-power thulium-doped fiber lasers for minimally invasive therapies in the biomedical field. Breakthrough results in four major clinical application scenarios, namely, urological lithotripsy, tumor precision ablation, disfiguring dermatological treatment, and minimally invasive endovenous laser ablation, are also summarized. By systematically evaluating its potential for multimodal diagnostic and therapeutic applications and thoroughly exploring the technical challenges and strategies for clinical transformation, we aim to provide a theoretical basis and practical guidance for the clinical transformation and industrialization of new-generation medical laser technology. Full article

Background: Treating varicosities originating from a popliteal fossa perforating vein (PFPV) is challenging due to their proximity to nerves and complex morphology. Data on endovenous laser ablation (EVLA) for PFPV varicosis are limited. Methods: This retrospective, single-center study reviewed all primary varicose vein surgeries from May 2021 to December 2024. Only primary PFPV varicosis cases with CEAP stage C2s or higher were included. Patients with recurrent disease or primary truncal insufficiency due to reflux from the saphenopopliteal junction were excluded. EVLA was performed using 1470 nm radial laser catheters, targeting the reflux source and downstream varicose segments. Tumescent solution was applied to protect the surrounding structures. The primary outcome was early technical success via duplex ultrasound; the secondary outcome was the complication rate. Results: Of the 2375 limbs treated, 44 (1.9%) involved PFPV. The cohort included 16 men (36%) and 28 women (64%), with a mean age of 54. The median follow-up was 14 days. Technical success was achieved in 41 cases (93.2%). Foam sclerotherapy with polidocanol was performed in eight patients (18.2%), exclusively for superficial residual varicosities and never simultaneously with EVLA. Three treatment failures required re-operation, two of which were successfully re-treated. Minor postoperative complications occurred in two patients (4.5%). No nerve injuries or thrombotic events were observed. Conclusions: EVLA shows promising very early technical efficacy, with low morbidity, for treating PFPV varicosis. Based on our findings, prospective studies investigating the mid- and long-term outcomes of this technique are warranted to further validate its clinical utility. Full article

Background: Blood flow from the saphenofemoral junction(SFJ) tributaries may cause recurrence of varicose veins. Flush occlusion is defined as the total occlusion of the great saphenous vein(GSV) right to the saphenofemoral junction. The purpose of this study was to evaluate the efficacy and safety of flush endovenous thermal ablation with saphenofemoral junction tributary occlusion. Method: Between January 2019 and December 2022, 722 patients (total of 1273 limbs) were diagnosed with chronic vein insufficiency by one surgeon at a single center. Result: Of the 722 patients, 476 (65.9%) were female and 246 (34.1%) were male. Of the 1273 limbs, endovenous laser ablation(EVLA) was performed in 609 limbs and radiofrequency ablation(RFA) in 664 limbs. Of the 1273 limbs, the recurrence rate was 3.69% (n = 47), the development of endovenous heat-induced thromboembolism(EHIT) was 0.31% (n = 4), and neovascularization was 1.49% (n = 19). Conclusions: Flush endovenous thermal ablation was an effective method for decreasing recurrence without inducing endovenous heat-induced thromboembolism. Consecutive foam sclerotherapy for saphenofemoral junction tributaries may be feasible for reducing the recurrence of varicose veins. Full article

Background: To investigate postprocedural pain after using an endovenous 1940 nm laser for great saphenous vein incompetence. Methods: A total of 72 patients were treated for symptomatic unilateral great saphenous incompetence using a 1940 nm laser device. All patients were treated using a standardized procedure under local anesthesia and investigated for postprocedural pain for 4 weeks using a visual analog scale (VAS 0-10). Results: Moderate pain was reported. A total of 17 patients reported minor scale 1 after the first day. On average, pain regressed to minor 1 after day 6. No significant complications were observed. Conclusions: Our results support the atraumatic character of this higher wavelength laser. In terms of patient comfort, higher wave lengths such as 1940 nm should be preferred for endovenous laser ablation. Using a combination of wavelengths could be the future solution to providing both safe ablation and minimum postprocedural pain. Full article

Background. Vasoactive drugs are considered an important therapeutic tool in managing phlebolymphologic disease. The current study was performed to evaluate the results of a high-dose diosmin-based combination (Venoplant 2g) in symptomatic patients with chronic venous disease (CVD), treated with endovascular venous surgery, regarding the efficacy of this treatment and the clinical signs and patients’ compliance. Methods: We identified, between April 2022 and March 2023, 50 patients with symptomatic CVD who underwent endovenous ablation and additionally were administered high-dose micronized diosmin. Parameters analyzed in the pre- and post-operative period were the venous clinical severity score (VCSS), the calf circumference, and a VEINES-QOL/Sym questionnaire. Treatment efficacy was assessed in post-operative follow-ups at 1 month and 2 months. Results: Quality-of-life analysis showed a significant improvement between t1 and t2 in both tests administered (VEINES-QOL/Sym: 55.2 ± 2.9, 39.2 ± 12.3, p: 0.001) (VCSS: 6.6 ± 1, 5.1 ± 0.7, p: 0.001). At the secondary endpoint, the results maintained the same improvement trend. Calf circumference was significantly reduced between t1 and t3 (41.7 ± 5.1, 38.3 ± 3.4, p: 0.001). Conclusion: High-dose diosmin, combined with sweet clover 320 mg, Centella asiatica 40 mg, and Vitamin C 200 mg, in patients treated with endovenous ablation, can be significantly effective in terms of clinical results in treating superficial venous disease. A patient’s calf circumference was also found to have decreased considerably during follow-up. No adverse effects have been recorded to date. Full article

Objective: This study aimed to examine whether body weight may affect the effectiveness and safety of endovenous thermal ablation (ETA) for the treatment of symptomatic varicose veins. Methods: This retrospective single-center cohort study analyzed the outcomes and patient demographic data with a focus on the body weight of all patients who had ETA of symptomatic varicose veins between September 2017 and October 2020. Results: A total of 1178 treated truncal veins from 636 patients were analyzed. The mean ± standard deviation body mass index (BMI) was 25.5 ± 4.9. In 2.3% of cases, the patients were underweight (BMI < 18.5), 31.0% were overweight (BMI > 25), and 16.6% were obese (BMI > 30). Complete truncal occlusion was observed 1 year post intervention in 97.6–100% and patients were satisfied or very satisfied in 96.2–100% across BMI groups. Pain was low but significantly higher in the patients with obesity 6 weeks post intervention (visual analog scale 0.84 ± 1.49) and a higher infection rate was observed in the patients with obesity (n = 4/132; 3.0%). No significant association was observed between BMI and bleeding or thromboembolic events. Conclusions: Patients with obesity experienced prolonged pain and more infections after ETA, but ETA for varicose vein treatment remains effective and safe, independent of the patient’s BMI. Full article

Endovenous thermal methods are superseding surgical stripping for treating chronic superficial venous disease but require tumescent anesthesia and can cause heat-related nerve injuries. Endovenous cyanoacrylate ablation is a more recent technique that does not share these drawbacks. A retrospective observational study of consecutive adults managed with endovenous cyanoacrylate was conducted in 2018–2021 at a single university center. The follow-up was 18 months. We identified factors associated with target vein closure at 18 months and measured changes in quality of life using the generic 36-item Short-Form (SF-36) tool and the venous disease-specific VEINES-QOL/Sym questionnaire. Adverse events were collected. In the 55 study patients with 67 treated veins, the closure rate at 18 months was 94% (95% CI, 85–98%). Target vein diameter ≥9.5 mm had 81% sensitivity and 75% specificity for predicting recanalization. Quality-of-life scores improved significantly (p < 0.001 for both surveys). The only adverse event was a type IV allergic reaction to cyanoacrylate that was resolved with corticosteroid and histamine-antagonist therapy. Endovenous cyanoacrylate ablation was highly effective and is safe in experienced hands. Studies are warranted to determine whether changes in the protocol increase the closure rate in patients with target veins ≥9.5 mm in diameter. Full article

Background: Heterogeneity regarding dosimetry and reporting of endovenous laser ablation (EVLA) mandates the development of a standardized protocol. This study presents the mid-term results of EVLA with 1940 nm-laser and radial-fibre, supported by a four-zone dosimetry tool. Materials and methods: Four anatomical dosimetry zones for great saphenous veins (GSV) and two for small saphenous veins (SSV) were defined with set power levels. Zone-1G (4 W) extended from the inguinal ligament to the apex of femoral triangle, Zone-2G (4 W) from the apex of femoral triangle to the upper border of patella. Zone-3G (3 W) from the patella to the tibial tuberosity. Zone-4G (2 W) extended from the tibial tuberosity to the ankle. Zone-1S from the sapheno-popliteal junction to the tibial tuberosity. Zone-2S from the tibial tuberosity to the ankle. Power was increased by 1 W for veins >10 mm and decreased by 1 W when fibre sticking was encountered. Pullback-velocity was max. 1 mm/s. Results: A total of 152 consecutive patients (185 procedures) were recruited. Mean follow-up time was 11.9 months. Mean linear endovenous energy density for GSV was Zone-1G:42 J/cm, Zone-2G:33 J/cm, Zone-3G:27 J/cm, Zone-4G:22 J/cm, Zone-1S:34 J/cm, Zone-2S:27 J/cm. Occlusion rates were 98.9% (1-month) and 93.7% (12-months). Complications at 1 M were low, namely laser-induced paraesthesia (LIP) 2.2% and endovenous heat-induced thrombosis (EHIT) 1.6%. Persistent LIP (12 M) was observed in 0.5%. Conclusion: The proposed four-zone guiding tool is a step towards standardizing dosimetry and documentation for EVLA with 1940 nm. This strategy shows good mid-term results with minimal complications. Long-term follow-up and application in further centres are necessary to prove its reproducibility. Such a guiding tool could improve the ability to analyse, compare and review different EVLA wavelengths and fibre types. Full article

Background: A large amount of sclerosant is needed for the treatment of saphenous vein insufficiency with mechanochemical ablation (MOCA) for three or four veins with chronic venous insufficiency. In addition, what constitutes a safe amount is not clearly defined. In this study, we evaluate the feasibility of the combined endovenous laser and mechanochemical ablation to reduce the amount of sclerosant as compared with mechanochemical ablation monotherapy. Methods: A total of 327 patients diagnosed with superficial vein insufficiency between June 2018 and May 2020 and treated in a single center by one surgeon were evaluated retrospectively. There were 130 patients included who were treated with mechanochemical ablation (MOCA, Group I) and 197 patients who were treated with combined endovenous laser ablation and mechanochemical ablation (EVLA and MOCA, Group II). Results: The amount of sodium tetradecyl sulfate (STD) used per number of limbs was 5.5 ± 2.05 mL in Group I and 4.51 ± 1.2 mL in Group II (p < 0.001). The amount of STD used per number of veins was 4.77 ± 1.91 mL versus 3.12 ± 1.02 mL in Groups I and II, respectively, (p < 0.001). Recanalization rates within 52 weeks were 0% (0/130) in Group I and 5.58% (11/197) in Group II, while after 52 weeks they were 2.31% (3/130) in Group I and 6.60% (13/197) Group II and were not statistically significant. Complications within 4 weeks were 3.84% and 7.11% in Groups I and II, respectively. Conclusions: The results of this study show that combined EVLA and MOCA reduces the amount of sclerosant per the number of veins and legs treated as compared with MOCA monotherapy for three or four veins with chronic venous insufficiency. The combined EVLA and MOCA treatment in patients with three or four varicose veins has few side effects, reduces the amount of sclerotic agent, and can be considered to be an effective treatment method for inducing venous occlusion. Full article

Non-thermal endovenous ablations, due to the lowest probability of complications, are the new method of treating chronic venous insufficiency—one of the most common diseases globally. The Flebogrif system (Balton Sp. z o.o., Warsaw, Poland) is a new mechano-chemical ablation system causing the mechanical damage of endothelium that allows for better sclerosant penetration into its wall. The purpose of the article is to provide mechanical characteristics in the form of force–displacement dependence for a single cutting element, and a bundle of cutting elements of Flebogrif as a whole for different levels of protrusion of the bundle of cutting elements. A TA.HD plus (Stable Micro Systems, Godalming, UK) analyzer equipped with special handles, was used for characteristics testing. The head movement speed used was 5 mm·s⁻¹. The Flebogrif system was tested for three cutting element protrusion levels: L = L_max, L = 0.9·L_max, and L = 0.8·L_max. Before testing, geometric measurement of the spacing of the cutting elements for three proposed protrusions was performed. It was established that decreasing the working length of the cutting elements will increase their rigidity, and, as a result, increase the force exerted on the internal surface of the vein wall. The obtained characteristics will allow for specifying contact force variability ranges and the corresponding diameter ranges of operated veins. Full article

The aim of this study was to demonstrate the effects of compression following the endovenous laser ablation (EVLA) of incompetent great saphenous veins (GSVs) using a 1470 nm diode laser (Ceralas E 1470 nm, biolitec) and a 2ring radial fiber (ELVeS Radial 2ring™, biolitec). In this single-center prospective study, 150 legs of 150 consecutive patients were randomly allocated to one of three groups (A, B, and C). Group A patients did not undergo postoperative compression. Group B patients wore a thigh-length graduated compression stocking (23–32 mmHg) for 7 days, whereas group C patients wore the same stocking for 28 days. No additional phlebectomies or sclerotherapies were performed. Investigations were performed prior to intervention, at the day of intervention (D0), at day 7 (D7), and at day 28 post intervention (D28). The primary endpoint was post-interventional pain measured on a 10-point scale. A significant but small pain decrease was observed in the first week of compression, by comparing group B’s mean pain scores to those of group A (p = 0.009). Wearing a compression stocking after EVLA reduced pain within the first week on a significant, but low level. Taking the very low differences in pain levels into account, the difference may not be clinically relevant and post-treatment compression may not be necessary if no additional phlebectomies or sclerotherapies are performed. Full article

Sclerotherapy is the chemical occlusion of vessels using an intravenous injection of a liquid or foamed sclerosing agent that is used in the therapy of blood and lymphatic vessels malformations in the young, and for spider veins, smaller varicose veins, hemorrhoids and hydroceles in adults. This study aimed to assess the effectiveness of mechanosclerotherapy of venous veins with a new device—Flebogrif^®—based on an animal model. The experiment was performed on nine Polish Merino sheep weighing 40–50 kilograms. The animals were anesthetized intravenously. The material was divided into three groups: two experimental (1 and 2) and control (3) group. The first experimental group was treated with the use of Flebogrif^® and a sclerosant simultaneously, while only Flebogrif^® was used in the second experimental group. Flebogrif^® was applied into the lateral saphenous vein of both pelvic limbs. The vessel wall thickness was estimated at four points of the histological image in mm (V1, V2, V3, V4). For one month, the animals were euthanized, and the occlusion rate of the treated veins and changes in the vein wall were determined. Histological slides were analyzed under a light microscope and histometry of the vein wall was performed. The Shapiro–Wilk test and the quantity of the investigated parameter groups allowed for using a non-parametric method at four points to compare thickness measurements (the Mann–Whitney test), with p < 0.05. The Mann–Whitney test indicated statistically significant differences between both experimental groups. The results obtained from morphometrical and histological analysis showed better results in the first experimental group than those of the second experimental group. Finally, statistical analysis revealed significant differences between the both the experimental group and control group in morphological analysis. The achieved results allowed us to conclude that the simultaneous use of Flebogrif^® and a sclerosant yielded better results of vein lumen reduction than the use of Flebogrif^® alone. Full article

Background: The current treatment of venous disease is focused on the minimally invasive exclusion of the affected vein. Besides widely used thermal ablation, chemical ablation with cyanoacrylate, reported as safe and highly effective, has been gaining increasing interest. Patients and methods: In the current report, we present data from a two-year observation in 89 patients (61 female/28 male, mean age 44.3 ± 13.5) suffering from venous insufficiency (C2–C4), treated either using short-chain cyanoacrylate, the VenaBlock system (n = 43) or laser thermoablation with ELVeS 1470 (n = 46). The assessment comprised the occurrence of venous disease-related symptoms and the ultrasound examination of the leg venous system. Results: The frequency of recanalization after 2 years from the VenaBlock procedure was significantly higher than after laser treatment (37.2 vs. 8.7%). Apart from recanalization, in some individuals from both groups, the symptoms of recurrence and/or disease progression, including the development of insufficiency in other veins of treated or contralateral legs (9.3 vs. 15.2% and 9.3 vs. 17.4%, respectively), were observed. Unexpectedly, the general prevalence of the disease progression did not differ significantly between the VenaBlock and ELVeS groups (44.2 vs. 34.8%, respectively). Conclusions: Despite the higher recanalization rate of VenaBlock compared to ELVeS, the overall effectiveness of cyanoacrylate and laser thermoablation after two years was similar. Therefore, both methods similarly failed to prevent recurrence and disease progression, which seem to be method-independent. Full article

Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU affects many individuals worldwide, could pose a significant socioeconomic burden to the healthcare system, and has major psychological and physical impacts on the affected individual. VLU often occurs in association with post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension. Several demographic, genetic, and environmental factors could trigger chronic venous disease with venous dilation, incompetent valves, venous reflux, and venous hypertension. Endothelial cell injury and changes in the glycocalyx, venous shear-stress, and adhesion molecules could be initiating events in VLU. Increased endothelial cell permeability and leukocyte infiltration, and increases in inflammatory cytokines, matrix metalloproteinases (MMPs), reactive oxygen and nitrogen species, iron deposition, and tissue metabolites also contribute to the pathogenesis of VLU. Treatment of VLU includes compression therapy and endovenous ablation to occlude the axial reflux. Other interventional approaches such as subfascial endoscopic perforator surgery and iliac venous stent have shown mixed results. With good wound care and compression therapy, VLU usually heals within 6 months. VLU healing involves orchestrated processes including hemostasis, inflammation, proliferation, and remodeling and the contribution of different cells including leukocytes, platelets, fibroblasts, vascular smooth muscle cells, endothelial cells, and keratinocytes as well as the release of various biomolecules including transforming growth factor-β, cytokines, chemokines, MMPs, tissue inhibitors of MMPs (TIMPs), elastase, urokinase plasminogen activator, fibrin, collagen, and albumin. Alterations in any of these physiological wound closure processes could delay VLU healing. Also, these histological and soluble biomarkers can be used for VLU diagnosis and assessment of its progression, responsiveness to healing, and prognosis. If not treated adequately, VLU could progress to non-healed or granulating VLU, causing physical immobility, reduced quality of life, cellulitis, severe infections, osteomyelitis, and neoplastic transformation. Recalcitrant VLU shows prolonged healing time with advanced age, obesity, nutritional deficiencies, colder temperature, preexisting venous disease, deep venous thrombosis, and larger wound area. VLU also has a high, 50–70% recurrence rate, likely due to noncompliance with compression therapy, failure of surgical procedures, incorrect ulcer diagnosis, progression of venous disease, and poorly understood pathophysiology. Understanding the molecular pathways underlying VLU has led to new lines of therapy with significant promise including biologics such as bilayer living skin construct, fibroblast derivatives, and extracellular matrices and non-biologic products such as poly-N-acetyl glucosamine, human placental membranes amnion/chorion allografts, ACT1 peptide inhibitor of connexin 43, sulodexide, growth factors, silver dressings, MMP inhibitors, and modulators of reactive oxygen and nitrogen species, the immune response and tissue metabolites. Preventive measures including compression therapy and venotonics could also reduce the risk of progression to chronic venous insufficiency and VLU in susceptible individuals. Full article