Krysa: Prevention of Complications of Endovenous Laser Treatment

Results and Discussion

Lower extremity saphenous varicose veins refer to the most common diseases. According to J. van der Stricht (1996), varicose vein disease (VVD) is the “price for walking upright and enjoying vertical lifestyle”. Statistics shows that various forms of VVD affect every third woman and every fifth man of working age.

Treatment of varicose vein disease should provide reliable exclusion of varicose veins from blood circulation, be minimally traumatic, provide a satisfactory aesthetic effect, prevent any dangerous or adverse effect on the patient, minimize side effects, and shorten the time of the postoperative rehabilitation [8].

In recent decades, there has been made considerable progress in treatment of lower extremity varicose vein disease (LEVVD) due to the development and introduction of new minimally invasive technologies, namely endovenous laser treatment (EVLT), which is gradually turning into a therapeutic method available for a wide range of surgeons in medical institutions of different levels. Endovenous laser technology has become a priority surgical treatment of LEVVD. This is due to its low traumatism, satisfactory aesthetic and cosmetic effect, possibility of early mobilization of the operated patients, and reduced rehabilitation time after surgical intervention [6, 11, 12].

The basic EVLT principle is local photothermal damage to the vessel wall by means of laser radiation with a certain wavelength, which is transmitted by the light guide to a coagulation zone. The laser energy causes thermal- and photocoagulation of the endothelium and vessel wall, vaporization (blood boils causing vapor bubbles heated to the temperature of 1000C), and blood carbonization in the vein lumen. Photothermal laser exposure results in the primary adhesion of the vessel walls, accompanied by the elastic extremity compression immediately after the intervention, and subsequent fibroid vessel degeneration [8].

The use of EVLT allows achieving optimal results in treatment of LEVVD. Thus, EVLT has become an alternative to classical operations. Sometimes it is even positioned as an ideal method for treatment of VVD. Laser technology, however, may often cause a number of complications inherent to this technique, in particular acute segmental thrombophlebitis, ecchymosis, skin hyperpigmentation in the coagulated vien projection, neurological disorders, paravasal burns extended to the skin, and vein recanalization in the remote period [2, 9].

Special attention should be paid to the complications, which are directly associated with laser treatment. In particular, during coagulation, multiple gas bubbles can be observed on the screen of the ultrasound machine, streaming to the vein lumen from the light guide end, which can be visible in the lumen of the coagulated vein for 7-10 minutes. They are constantly moving in the proximal direction and enter the central venous system, pulmonary circulation in the lungs, and blood vessels of the brain through sapheno-femorale fistula. In the early postoperative period, most of the operated patients (83%) having gas bubbles in the venous system suffer from headache, dizziness, nausea, feeling of “heaviness” when breathing, general weakness, and malaise. These symptoms usually last for 6-7 days after surgery and may affect the course of the early postoperative period [1, 3].

Some authors claim that a laser vaporization phenomenon is manifested in specific diagnostic and clinical symptoms. They suggest that endovenous laser coagulation should be complemented by crossectomy [4, 7]. Crossectomy, however, neither warns nor eliminates the development of EVLT specific complications due to the fact that gas bubbles in combination with the products of laser photocoagulation and carbonization can enter the deep venous system through multiple perforating veins in the thigh and lower leg, which normally carry blood from the saphenous veins into the deep veins. At the same time, a number of authors, who perform EVLT on the outpatient basis, usually avoid crossectomy in order not to complicate the procedure of intervention [10].

It is possible to achieve the task by draining the coagulation zone and removing products of vaporization, photocoagulation and carbonization, while performing EVLT, from the lumen of the vein through a drainage catheter, connected to the vacuum source.

There has been suggested the method for preventing complications specific to EVLT by active removal of laser coagulation products, which are formed at the working end of the light guide, in order to minimize the number of these products entering the central venous system, pulmonary circulation in the lungs, and blood vessels of the brain through sapheno-femorale fistula and perforating veins (UA patent application u201605586) [5].


The implementation of the proposed method for preventing complications specific to EVLT enables to exclude the specified complications of LEVVD during the early postoperative period, if they are caused by the products resulting from vaporization and photocoagulation, which are able to enter the pulmonary circulation and blood vessels of the brain through the venous system. Moreover, it contributes to the postoperative recovery of the operated patients with no need for crossectomy.



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Copyright (c) 2017 Bohdan Vasylovych Krysa

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