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INTRODUCTION

When saphenous system reflux is present, it must be addressed prior to treatment of visible and associated varicosities, reticular veins, or telangiectasias. Endovenous occlusion techniques using radiofrequency (RF) or laser have become the standard of care in the United States. When using laser, they are termed ELT or ELA, which are abbreviations for endovenous laser therapy or treatment or endovenous laser ablation, respectively. Without elimination of reflux, the patient will be doomed to recurrence after recurrence of varicosities below the level of saphenous vein reflux. Previously, the only treatment option for these patients with varicose veins from saphenous insufficiency was surgical ligation and stripping of the vessels under general anesthesia. This procedure resulted in significant postoperative down time, with surgical scars, swelling, bruising, and pain. The expense of a hospital stay and missed work, along with an unacceptable rate of recurrence, has greatly decreased the popularity of this procedure and relegated it to low technology medical arenas (see Chapter 23). Like many other fields of medicine, varicose vein treatment in the 21st century has evolved and adopted less-invasive methods. RF ablation started the minimally invasive varicose vein trend with approval in March 1999 by the U.S. Food and Drug Administration (FDA) as the Closure® procedure (VNUS Medical Technologies, San Jose, CA). Endovenous ablation techniques utilizing lasers were subsequently filed as U.S. FDA 510(k) applications as substantially equivalent procedures to RF ablation. The first laser FDA cleared by substantial equivalence to RF was the 810-nm diode laser, which was cleared for marketing in 2000.

The advances in endovenous ablation have revolutionized in-office varicose vein treatment for physicians and patients. Table 21-1 summarizes the laser endovenous systems and their trade names. Lasers can be thought of in two categories: hemoglobin absorption predominant and water absorption predominant. The water absorption predominant wavelengths are primarily above 1100 nm in which hemoglobin is no longer a chromophore (Figure 21-1). There are numerous advantages to predominant water absorption, which are discussed below.

TABLE 21-1Endovenous Lasers and Associated Trade Names
FIGURE 21-1

Absorption curves of light through infrared wavelengths. There is virtually no absorption by hemoglobin beyond 1100 nm. Water is the target of 1320 nm.

LASERS WITH HEMOGLOBIN ABSORPTION PREDOMINANT (810, 940, 980, AND 1064 nm)

Endovenous laser treatment with these wavelengths is designed to produce endothelial ...

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