Endovenous laser ablation for varicose veins: towards a personalized energy dose

Background: Endovenous laser ablation is a minimally invasive procedure in the treatment of great saphenous vein insufficiency. Procedural criteria (energy delivered according to the selected fluence) could affect outcome after treatment, potentially improving the success rate and reducing complications. However, the optimal values of the required energy per unit volume are not known, but on the basis of clinical experience, a range of optimal speed of retraction of the laser fiber catheter should exist and strictly depend on the actual vein dimensions. Methods: The study population included 21 patients. The equipment was a Diomed 30W® laser, wavelength 810 nm. Before treatment, three segments of the great saphenous vein were mapped and their diameter measured and recorded. The energy delivered to each segment was recorded as well as its relationship with vein diameter being evaluated for each vein segment. Results: A 100% success rate was observed at 12-month follow-up assessment, the discomfort complaint 1 week after endovenous laser ablation by 19% of patients was always low (2 or 3 on a scale of pain of 10). On the basis of the actual result, which greatly improves our previous clinical experience, a range of effective values of speed of retraction of the laser fiber catheter (and of the energy per unit volume) is assessed, which strictly depends on the diameter of each segment of the vein. Conclusion: The speed of retraction of the laser fiber catheter should be properly tailored, in order to deliver the right energy dose depending on the actual vein diameter. A real-time procedure can be easily performed using a simple mathematical nomogram.