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Phlebologie 2015; 44(02): 63-65
DOI: 10.12687/phleb2254-2-2015
Originalarbeit
Schattauer GmbH

Side effects and occlusion rate after tumescentless treatment of the great saphenous vein with EVLA

Retrospective analysisNebenwirkungen und Verschlussrate nach einer tumeszenzlosen Behandlung der V. saphena magna mit der endovenösen LaserablationRetrospective analysis
S. Schuller-Petrović
1   VENEX Vein Center, Vienna, Austria; Dermatology Center Parmova, Ljubljana, Slovenia
,
S. Schuller
1   VENEX Vein Center, Vienna, Austria; Dermatology Center Parmova, Ljubljana, Slovenia
,
B. Schuller-Lukić
1   VENEX Vein Center, Vienna, Austria; Dermatology Center Parmova, Ljubljana, Slovenia
,
M. D. Pavlović
1   VENEX Vein Center, Vienna, Austria; Dermatology Center Parmova, Ljubljana, Slovenia
› Author Affiliations
Further Information

Publication History

Received: 16 January 2015

Accepted: 30 March 2015

Publication Date:
04 January 2018 (online)

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Summary

We have performed a retrospective analysis of side-effect profile of endovenous laser ablation (EVLA) of great saphenous veins in patients operated on in general sedation or general/regional anesthesia with or without tumescence solution injection. The results confirmed our initial assumptions that omitting tumescence (and in addition, avoiding any external compression and cooling) may actually significantly reduce the incidence of moderate/severe postoperative pain and brusing without compromising closure rates. As these are probably caused by vessel wall perforations they seem to be more common in the tumescence cohort. The results are in line with recent basic research which showed that fiber tip centering may reduce perforations (easier to perform in vessels filled with blood), that blood itself does not either reduce or enhance laser‘s effect, and that various lasers over a wide range of wavelengths (from hemoglobin-absorbing to water-absorbing) have comparable clinical efficacy. Hence, omitting tumescence and external compression probably reduces the incidence of postoperative pain and brusing in patients treated with EVLA.

Zusammenfassung

Es wurde eine retrospektive Analyse des Nebenwirkungsprofils nach endovenöser Laser-ablation (EVLA) der V. saphena magna unter Allgemeinanästhesie oder Spinalanästhesie, mit oder ohne Infiltration einer Tumeszenzlö-sung durchgeführt. Die Resultate haben unsere Vermutung bestätigt, dass das Weglassen der Tumeszenzlösung (auch ohne zusätzliche externe Kompression oder Kühlung) die Inzidenz der postoperativen mäßigen/starken Schmerzen und Hämatome signifikant reduzieren kann, ohne eine Verminderung der Verschlussrate. Da die Beschwerden wahrscheinlich durch die Perforation der Venenwand bedingt sind, scheinen sie in der Gruppe mit Infiltration der Tumeszenzlösung häufiger aufzutreten. Diese Resultate gehen konform mit rezenten Basisforschungen, die gezeigt haben, dass die Zentrierung der Laserspitze (leichter durchführbar in blutgefüllten Gefäßen) Perforationen minimieren kann, dass das Blut selbst weder den Effekt des Lasers vermindert noch erhöht, und dass die verschiedenen Laserwellenlängen (von Hämoglobin absorbierenden bis zu den Wasser absorbierenden) vergleichbare klinische Effektivität haben. Daher scheint das Weglassen der Tumeszenzlösung bei Patienten, die mit EVLA behandelt wurden, die Inzidenz der postoperativen Beschwerden wie Schmerzen und Hämatomen zu vermindern.

Keywords

Endovenous laser ablation (EVLA) - tumescence - compression - ecchymosis - great saphenous vein

Schlüsselwörter

Endovenöse Laserablation - Tumeszenz - Kompression - Vena saphena magna
 

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