1470nm Laser EVLA
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Transcript of 1470nm Laser EVLA
RGV Vein Laser and Aesthetic Clinic, Brownsville, TX.The Body Sculpting Center, Scottsdale, AZ.
Optimal Energy Delivery Dose for Successful Saphenous
Endovenous Laser Ablation Using the 1470-nm Diode
LaserFiliberto Rodriguez MD,
Margaret Clark RN, Thomas A Clark MD
Endovenous laser ablation (EVLA) is well established for treatment of saphenous vein reflux
Traditional 810 to 980-nm wavelengths have been associated with:- Post-procedure paresthesia- Pain - Ecchymosis
Introduction
Newer wavelengths (1330-nm and 1470-nm) hold potential for successful EVLA with decreased pain both during and after the procedure
Literature is conflicting, with high energy settings for the 1470-nm laser (7-15W) and comparing results using bare-tipped versus radial emitting fibers
Introduction
Quantify the optimal energy delivery dose for EVLA with the 1470-nm laser
Compare efficacy outcomes and post-procedure pain with the 810-nm laser
using bare-tipped fibers for both
Purpose
Understanding Wavelength Targets
De Felice Phlebology.2010; 25: 11-28
810-nm 1470-nm
1470-nm laser associated with decreased energy requirement for
EVLA, which may translate into decreased post-procedure pain
Hypothesis
A retrospective chart review was performed from August 2009, when we first began using the 1470-nm laser, through May 2010 (10 months)
The 1470-nm laser was utilized in one clinic while the 810-nm laser was used simultaneously in a second location
Methods
All EVLA procedures were performed- in an outpatient setting- in a sterile manner- via Seldinger technique- under local tumescent
anesthesia- using bare-tipped laser fibers
Methods
Ultrasound guidance utilized: - vascular access
Methods
Methods
Methods
Endoluminal Opacification
Wattage settings for the Diomed 810-nm laser were consistent: – 14W for all GSV EVLAs
– 12W for all SSV EVLAs
Wattage settings for the ThermaLite™ 1470-nm– Initially set at 6W for all GSV EVLAs
– adjusted as our experience grew
Methods
Measurements were recorded for:- vein segment lengths
- diameter
- laser wattage setting
- total joules delivered
- post-procedure pain (0-5 scale, post-op day 1)
Methods
Results
r = 0.526284, p<0.05
Results
Successful EVLA was similar (99.6% vs. 100%), with one failure during the early adoption of the 1470-nm laser - energy delivery dose was only 16J/cm
- successfully treated with repeat 1470-nm EVLA (38.8J/cm)
Results
Trend towards decreased post-procedure pain with the 1470-nm laser (1.08/5 vs. 1.33/5), although this failed to reach statistical significance- Possible Type-II statistical error
- limited sample size with unequal numbers
- qualitative measure of post-procedure pain at a single time-point (post-procedure day 1)
Anecdotal experience is that the 1470-nm is better tolerated than the 810-nm laser both during the procedure and after
Results
Conclusions
The 1470-nm laser can be used for successful EVLA with significantly less energy compared with the 810-nm laser
This decreased energy may translate into decreased pain during and after EVLA
An energy delivery dose of only 25-30 J/cm ensures therapeutic success with the new 1470-nm wavelength
The wattage setting of 4-5 W is determined in correlation with the vessel diameter
Thank You