Abstract: Objective: This clinical trial aimed to evaluate the clinical results of the use of a tulip fibre versus the use of a bare fibre for endovenous laser ablation.
Methods: In a multicentre prospective randomised trial 174 patients were randomised for the treatment of great saphenous vein reflux. A duplex scan was scheduled 1 month, 6 months and 1 year postoperatively.
Ecchymosis was measured on the 5th postoperative day. In addition, pain, analgesics requirement, postoperative quality of life (CIVIQ 2) and patient satisfaction rate were noted.
Results: Patients treated with a tulip fibre had significantly less postoperative ecchymosis (0.04 vs. 0.21; p < 0.001) and pain (5th day) (1.00 vs. 2.00; p < 0.001) and had a better postoperative quality of life (27 vs. 32; p 1â4 0.023). There was no difference in analgesic intake (p 1â4 0.11) and patient satisfaction rate (p 1â4 0.564). The total occlusion rate at 1 year was 97.02% and there was no significant difference between the two groups (p 1â4 0.309).
Conclusion: Using a tulip fibre for EVLA of the great saphenous vein results, when compared with the use of a bare fibre, in equal occlusion rates at 1 year but causes less postoperative ecchymosis and pain and in a better postoperative quality of life.
Abstract: Background: The aim of this article is to summarize and review the proposed theories on the 71 laser action during endovenous ablation. 72 Methods: Laser mechanics and laseretissue interaction are summarized from articles found in 73 literature. Several theories, like the ââsteam bubble theory,ââ the ââdirect contact theory,ââ the ââheat 74 pipe,ââ and ââdirect light energy absorptionââ are discussed. 75 Results: The laser light emitted intraluminally can be absorbed, scattered, or reflected. Reflec- 76 tion is negligible in the near-infrared spectrum. By combining absorption and scattering, the 77 optical extinction of different wavelengths related to different biological tissues can be deter- 78 mined. The direct contact of the fiber tip and the vein wall may be a way of destroying the 79 vein wall, but results in ulcerations and perforations of the vein wall. Avoiding this contact,
and acting as direct light absorption into the vein wall, results in a more homogenous vein 80 wall destruction. If the energy is mainly absorbed by the intraluminal blood, the laser fiber will 81 act as a heat pipe. Histological studies show that a more circumferential vein wall destruction 82 can be obtained when the vein is emptied of its intraluminal blood. The use of tumescent liquid 83 reinforces spasm of the vein and protects the perivenous tissue. 84 Conclusion: Several factors play an important role in the mechanism of endovenous laser 85 ablation. Direct energy absorption by the vein wall is the most efficient mechanism. It is impor- 86 tant to empty the vein of its intraluminal blood and to inject tumescent liquid around the vein.
Abstract: OBJECTIVE: In this histological study, the lateral saphenous vein of the goat was treated using a laser fibre to which a tulip-shaped, self-expandable catheter had been fixed to achieve endovenous laser ablation (EVLA). The catheter centres the laser fibre in the vein preventing direct contact with the vein wall. This study aims to establish whether prevention of direct contact between the fibre tip and the vein wall prevents ulceration and perforation of the vein wall and perivenous tissue destruction. MATERIALS AND METHODS: Ten lateral saphenous veins were treated, using the tulip catheter, in goats under general anaesthesia. Ten more veins were treated with a normal bare fibre. We used a 980 nm diode laser to provide the energy. Postoperatively the veins were removed immediately, at 10 days and after 3 weeks for histological examination. Destruction of the vessel wall was measured and perivenous tissue destruction was quantified using a graded scale. RESULTS: Ulceration and perforation were prevented when using the tulip catheter. It also achieved more even vein wall necrosis. Tulip-catheter-treated veins show a transmural vein wall necrosis in, on average, 80% of the total circumference compared to 64% in bare-fibre treated veins. Less perivenous tissue destruction was seen with the new catheter (perivenous tissue destruction scale: tulip catheter: 1.7 vs. bare fibre: 3.8). Three weeks after treatment, we found regression of the perivenous tissue destruction as the healing process continued. CONCLUSIONS: EVLA using the tulip catheter avoids ulceration and perforation of the vein associated with treatment using a bare fibre. It also results in more even circumferential vein wall necrosis and less perivenous tissue destruction.
Abstract: BACKGROUND: A new endovenous laser wavelength (1,500 nm diode laser) in the treatment of great saphenous vein (GSV) reflux was evaluated. We studied the occlusion rate at 6 months and noted possible side effects. METHODS: In 129 patients, 158 GSVs were treated using the 1,500 nm diode laser. An average linear endovenous energy density of 53.4 J/cm and an average endovenous fluence of 32.21 J/cm(2) were administrated to the vein. RESULTS: The occlusion rate at 6 months postoperative was 93.3%. Some of the nonoccluded veins closed spontaneously. A postoperative foam treatment was necessary in 3.4% of the treated veins. We found a marked shrinkage of the treated veins. There were limited side effects: moderate or severe ecchymosis in 19%, moderate pain in 1%, moderate periphlebitis in 8.2%, with no paresthesias. CONCLUSION: Endovenous laser treatment of the GSV using a 1,500 nm diode laser is effective and safe. The marked shrinkage of the treated veins can guarantee good long-term results.
Abstract: OBJECTIVES: The destruction induced during endovenous laser treatment (ELT) of the saphenous vein and the perivenous tissue in an animal model (goats) was analysed. Differences in vein wall destruction produced by two laser types, the 980 and 1500 nm diode lasers, were evaluated histologically. METHODS: In 14 goats, 28 lateral saphenous veins were treated with ELT. In 14 veins we used the 980 nm diode laser and in the remnant a 1500 nm laser. Postoperatively the veins were removed at different stages and sent for histological examination. RESULTS: Immediately removed veins after ELT show an uneven destruction of the vein wall. Veins harvested one week postoperatively show inflammatory tissue at their periphery. Two and three weeks postoperatively, organization is very extensive. In some cases, recanalization begins in a semi-lunar manner at the contralateral side of the laser hit. Veins treated with a 980 nm laser show deeper ulceration with more perivenous tissue destruction compared with veins treated with a 1500 nm diode laser. CONCLUSIONS: The ELT of veins produces an unevenly distributed damage. The cell necrosis is far more extensive than expected. Uneven vein wall destruction can lead to recanalization. Using a 1500 nm laser correlates with less penetrating ulcerations and more circumferential damage.
Abstract: The aim of this study was to report the results of high-energy endovenous laser treatment to measure the relationship between the fluence and the outcome in terms of recanalization. In 97 patients, 129 great saphenous veins were treated with endovenous laser treatment, using a 980-nm diode laser. Follow-up visits were done at 3 days, 1 month, and 6 months. The best results were noted 1 month postoperative, but at 6 months, control late recanalizations occurred decreasing occlusion rate to 90.6%. Patients were divided into 2 groups according to the outcome (occlusion or recanalization) at 6 months, and statistical analysis was done. The authors found 52 J/cm(2) mean fluence in the occlusion group and 43.7 J/cm(2) in the nonocclusion group. This was a statistical significant difference (P < .01). The occlusion rate on long term is fluence dependent. But recanalizations might occur even in these higher fluence treatment groups. A fluence of 52 J/cm(2) is advised.
Abstract: This case report describes the treatment by radiological intervention combined with therapeutic relaparoscopy of a patient with a gluteolumbar fistula due to lost gallstones 5 years after laparoscopic cholecystectomy.
Abstract: Nocardia is a gram positive, aerobic branched actinomycete; it is an ubiquitous soil saprophyte. As an infecting agent it has been increasingly identified in humans, especially in immuno-suppressed hosts. Nocardia as a cause of septic arthritis is very unusual. The described genus was Nocardia asteroides in nearly all previously reported cases. We report an unusual case of spontaneous Nocardia farcinica septic arthritis of the left knee in a 68-year-old man, who was under systemic corticosteroids for chronic obstructive pulmonary disease. The diagnosis was rapidly made by Gram and acid-fast stains and later confirmed by culture. PCR was used to identify the subtype. The patient was treated successfully with sulphametaxazole-trimethoprim for six months. Our case re-emphasises, especially in the immuno-compromised patient, the importance of performing fungal and acid-fast bacilli cultures, besides the most common bacterial cultures for aerobic and anaerobic organisms, in order to identify less common organisms and to initiate early and adequate treatment.
Abstract: Pseudoaneurysm formation is a rare complication after knee arthroscopy. Most pseudoaneurysms complicating knee arthroscopy develop on the popliteal and geniculate arteries. We report a case of a pseudoaneurysm developed on an arterial branch to the medial gastrocnemius muscle, as a complication of an arthroscopic meniscectomy in a 66-year-old patient. The patient was treated successfully by resection of the pseudoaneurysm and ligation of the injured artery.
