Varicose veins are a common condition in many parts of the world. Approximately 40% of women and 25% of men experience a variety of associated symptoms, including mild to severe leg discomfort, fatigue, pain and swelling. If left untreated it can lead to soft tissue necrosis and ulcers.
More than one million people in the United States and Europe undergo surgery each year. A minimally invasive alternative treatment that can be performed on an outpatient basis would provide significant cost savings and efficiencies for healthcare organizations.
Laser treatment of varicose veins is such a technology.
It applies the energy of a Diomed 810nm semiconductor laser through a very thin optical fiber directly into the saphenous vein. The laser heat is used to permanently close the vein, thus removing the underlying cause of varicose veins.
2. Principle of laser treatment of varicose veins (EVLT):
The laser heat energy precisely destroys the blood vessel wall and makes the blood vessel closed and fibrotic.
3. Contraindications for laser treatment of varicose veins:
Macrocirculatory disorders
Braking
Deep vein thrombosis of the lower extremities
Hypercoagulability of the blood
Pregnancy
Poor general health
4. Procedure of laser treatment of varicose veins
The first step: pre-operative preparation
The patient describes his condition
(1) A comprehensive examination of the legs is performed, and the point of reflux is measured and the saphenous vein is traced with continuous Doppler and bidirectional ultrasound
(2) Transverse measurements are made along the lower saphenous vein at the confluence of saphenofemoral veins at a distance of 2cm~3cm
(3) The diameter of the saphenous vein is obtained as well as the picture of the reflux
(4) The need for the laser treatment of varicose veins is marked and the patient is given a description of the condition. p> (4) Indicate the length of the vein to be treated
(5) Take preoperative color pictures of varicose veins in the legs
(6) If necessary, the patient can be sedated before the operation (XANANX 0.5 one hour before the operation)
Part II: Surgical Procedure
(1) Legs are sterilized sterilely, covered by perforated towel, and ultrasound probe is placed into the sterile probe cover.
(2) The patient lies horizontally with the head upward, and under local anesthesia, using ultrasound guidance, a 7-cm-long 19-gauge puncture needle is used to access the saphenous vein by percutaneous puncture near the knee or at the inner ankle. (Making a small incision in the skin at the puncture point will aid in the puncture)
(3) A 0.035-inch guidewire is introduced into the saphenous vein through the puncture
(4) The needle is removed, and a 45-cm-long 5 Fr cannula is introduced through the guidewire as far as the sapheno-femoral vein confluence (under ultrasound guidance)
(5) The internal dilator and guidewire are removed, and the syringe is used to draw back the (5) Remove the internal dilator and guidewire, and draw back blood with a syringe to determine if the catheter is entering the vein correctly, such as saline, to flush the inner wall of the catheter
(6) The surgical staff and the patient should wear 810 nm laser goggles
(7) Connect a DynaMed sterile fiber optic to the DynaMed laser (a 600 um fiber optic with a sterility strip marker)
(8) Insert the 810 um bare fiber optic into the cannula until the first sterile strip marker reaches the entry point, and insert it into the cannula, until the first sterile strip marker reaches the entry point. until the first sterile strip marker reaches the entrance, at which point the end of the fiber is in line with the cannula. (Under ultrasound guidance)
(9) The position of the cannula and fiber optic in the saphenous vein is detected ultrasonographically, and the cannula and fiber optic end are positioned 1 cm to 2 cm below the saphenofemoral venous confluence
(10) The fiber optic is set to READY mode, and the fiber optic end is seen in the red aiming beam
(11) The fiber optic is left in place, and the cannula needle is pulled back 3 cm until the second sterile strip marker reaches the entrance of the fiber optic. 3 CM until the second mark of the fiber reaches the entrance, at which point about 3 CM of the light end is exposed in the vein outside the cannula. Tape the cannula to the fiber to prevent misalignment
(12) Through the skin, through the red targeting beam can look directly at the end of the fiber to locate the fiber, can also be located by ultrasound
(13) Along the periphery of the great saphenous vein injected with 35CC ~ 100CC of 0.3% lidocaine without adrenaline for local anesthesia. (The choice of time period for local anesthesia depends on different doctors)
(14) Under ultrasound, the position of the end of the laser fiber is finally detected (1CM~2CM below the confluence of the saphenofemoral vein)
(15) Parameter settings: repetitive pulse pattern of 12W, 1-second pulses, and 1-second intervals (i.e., the laser is emitted for 1 second, and there is a 1-second pause)
(16) Decrease room Brightness, check the position of the end of the fiber with the red aiming beam
(17) Press the hand at the red aiming beam, it is the end of the fiber that is close to the vessel wall, and contact treatment has been achieved
(18) When the laser is emitted, the surgeon slowly pumps back the fiber in steps of 2MM~3MM until the desired saphenous vein has been treated and the surgical procedure is finished
(19) During the procedure, the total number of pulses can be calculated (total laser energy divided by power) and the pulse factor per centimeter can be calculated (total number of pulses divided by length)
. The ideal is 3-4 pulses per centimeter of vein
Part III: Post-operative precautions
(1) The patient is required to use an elastic bandage for 3 days (different bandages are available for different surgeons)
(2) The patient performs a 20-minute post-operative walk and is sent home: postoperative class II stockings are worn for 7 days after the procedure
(3) The patient is allowed to carry out his/her normal activities. Avoid hot baths and strenuous physical activity (4) Postoperative review with continuous wave Doppler and color bi-directional ultrasound at one week, one month, three months and six months intervals to confirm vascular closure, and annual follow up is recommended
5 Equipment needed for laser treatment of varicose veins
810NM Dyneme Semiconductor Laser Products D15 Enhanced
810NM Laser Goggles
60UMEVLT Fiber Optics
19G, 7CM Percutaneous Lancing Needle
45CM Long 5Fr Cannulae
0.035" Guidewire
Sterile Surgical Towel
Sterile medical tape