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Compare Alternatives: Endovenous Laser (EVL)
Endovenous Laser (EVL)
Endovenous Laser (EVL) is a minimally invasive procedure that utilizes an optical fiber to deliver laser energy and heat the blood inside the saphenous vein. The endovenous laser delivers energy that boils the blood, producing steam that damages the vein and creates a blood clot. The optical fiber is withdrawn while laser energy is delivered, inducing a blood clot to occlude the length of the treated vein.
A September 2003 article in the Journal of Vascular Surgery reported that 67% of EVL patients had pain for a median of one week (with a range of 0.2 to 8 weeks) and 51% used prescription pain medication. Another study of EVL published in an article in April 2002 in the Journal of Vascular Surgery describes laser-induced vein perforation, with bruising in patients lasting approximately two weeks. EVL efficacy is depicted in single center reports as achieving vein occlusion rates of 90% to 97% at one-year follow-up, and 93% at two-year follow up.
Drawbacks of the current EVL procedure and technology are significant in that they do not provide feedback during treatment to guide laser energy delivery or optical fiber withdrawal speed to reflect variability in vein size and blood volume. Without guidance from feedback, EVL can result in undesirable treatment outcomes such as perforation of the vein wall or a large blood clot along the treated vein. This creates the potential for:
- significant pain, tenderness, bruising and skin discoloration during the post-operative period; and
- veins to reopen from naturally occurring clot dissolving agents.
In an independent comparative study of the Closure system versus Endovenous Laser, patients’ legs treated with the Closure procedure exhibited significantly better results, as demonstrated by higher rates of vein occlusion, less bruising and less post-operative pain.
Read the story of a patient who underwent both the endovenous laser treatment and Closure procedure.
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Post-Treatment
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1. Procedures performed at regional ACP Meeting, June 2001.
2. Data on File - VNUS Medical Technologies, Inc.
3. Lurie, F, et al.Prospective randomized study of endovenous radiofrequency obliteration (Closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study), J Vasc Surg 2003; 38(2):207-14.
4. Merchant RF, DePalma RG, Kabnick LS. Endovascular obliteration of saphenous reflux: A multicenter study. J Vasc Surg 2002;35:1190-6
5. Weiss RA, et al. Controlled Radiofrequency Endovenous Occlusion Using a Unique Radiofrequency Catheter Under Duplex Guidance to Eliminate Saphenous Varicose Vein Reflux: A 2-Year Follow-up, Dermatologic Surgery, Jan 2002; 28:1: 38-42
6. Jones L, et al. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomized trial of stripping the long saphenous vein, Eur J Vasc Endovasc Surg, 1996; 12: 442-445
7. Morrison N. Presented at the Union Internationale de Phlebologie, Rome, September 2001.
8. Pichot O, et al. Role of Duplex Imaging in Endovenous Obliteration for Primary Venous Insufficiency. J. Endovasc Ther 2000; 7:451-9.
9. Proebstle TM, et al. Endovenous Treatment of the Greater Saphenous Vein with a 940 nm Diode Laser: Thrombotic Occlusion after Endoluminal Thermal Damage by Laser Generated Steam Bubbles, J Vasc Surg 2002; 35: 729-736.
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