Traditional and endovascular repair of abdominal aortic aneurysms in the presence of a horseshoe kidney

Endovenous Laser Treatment of Varicose Veins: A Three Years Personal Experience.
D. Kontothanassis°^, A. Scuro°^, A. Griso^, M. Mirandola^, C. Gavioli°, G. Camporese,° §
S. Scarpa° , L. Rampazzo*
University of Verona , School of Medicine – Verona, Italy ^
University of Padua, School of Medicine – Padua, Italy*
University of Padua, School of Medicine – Padua , Italy §
S.Mary’s Maddalen Hospital – Occhiobello –Rovigo- Italy °
Department of Surgical and Gastroenterological Sciences
Unit of Vascular Surgery ^
Department of Surgical and Gastroenterological Sciences
1st Clinica Chirurgica*
Department of Angiology §
INTRODUCTION : Endovenous Laser Treatment ELVeS for varicose veins is a new promising
procedure. We report our findings based on three years of experience with patients in order to demonstrate
the efficacy and safety of this technique.
METHODS : From April 2001 to December 2004 256 varicose veins ( 236 great saphenous veins and 20
lesser saphenous veins) ,(184F /72M) , were treated by the authors. The mean age of the patients was 60.42
years (29-83). The mean diameter of the treated veins was 7.2mm (4 -14mm). We thoroughly informed
patients about the procedure, operation risks, possibility of disease recurrence in case of recanalization of
the vein, and the limited amount of available data on the long term efficacy of this technique, and the
patients signed the written informed consent form. Before starting the operation an echocolordoppler study
was performed in order to exclude anatomical variants of the GSV, superficial thromboflebitis and deep vein
thrombosis. Under local anaesthesia (2 ml 1% Lidocaine) and ultrasonographic guidance, the GSV was
punctured in 182 cases at about 5 cm below the median condilus of the knee, and in 54 case at about 5-10
cm above the Knee ; The LSV was punctured in 7 cases at the external malleolus and in 13 case at 10-15 cm
above this. A J-guide wire was inserted into the GSV or LSV and positioned 1cm beyond the sapheno-
femoral junction (SFJ) into the common femoral vein or in the sapheno-popliteal junction (SPJ) into the
popliteal vein. A 5-F introducer sheath was positioned to cover the J-guide wire. The guide wire and the
sheath were flushed and a 600 µm laser fiber (Biolitec°) was inserted at the end of the 5-F intoducer sheath.
The sheath was then withdrawn up to a site mark indicating the last 2 cm of the laser fibre. The correct
position of the fibre tip was confirmed by direct visualization of the red transluminant light beam of the laser
fibre through the skin. Tumescent local anesthesia (45 ml of 0.25% Mepivacaine hydrochloride, neutralized
with sodium bicarbonate) was delivered along the perivenous space under sonographic guidance in order to
avoid accidental puncture of the vein. In order to obtain a non-thrombotic occlusion of the vein, laser energy
was delivered at 810 nm wavelength in 210 patients and at 980nm in 46 patients, using a 600 µm laser
fibre. Instrument settings were: power 12W, pulse duration 1 sec, interval between pulses 1 sec.
RESULTS: Immediate collapse of the GSV or LSV and absence of flow was assisted after the procedure
and confirmed by echocolordoppler study. There was no damage of the femoral vein, no deep vein
thrombosis, no skin burns, no paresthesias, no pain, no phlebitis and no other adverse reactions
intraoperatively. Postoperative ecchymosis was minimal and observed in almost all patients. Two patients
presented immediate recanalizzation after one week and one patient after 2 months (1,17%). Successful
occlusion, defined as vein occlusion with absence of flow was noted in 233 GSV (98,8%),and 20 LSV
(100%). Complete resolution of clinical symptoms became evident soon after the operation. The
echocolordoppler study demonstrated absence of flow in the treated veins. At 7 days, two month, six
month, 12 month and 18 month intervals the treated portions of the GSV were not visible on duplex
imaging.

CONCLUSIONS: Endovenous Laser Treatment of the GSV seems to offer a safer alternative to traditional
surgery (ligation and stripping). Early and mid term results of Endovenous Laser Treatment of incompetent
greater and lesser saphenous veins have been promising. This minimally invasive technique appears to be
safe, easy to perform, well tolerated, with lower rates of complication and the avoidance of general or
epidural anaesthesia. Continued evaluation with a larger numbers of patients and longer-term follow-up are
needed to further define the role of endovenous techniques as treatment alternatives in patients with cronic
vein insufficiency.

Source: http://www.chirurgiadellevarici.it/public/%5Callegati%5Celves%20%20rio%20%20uip.pdf