Proffesional diode laser- CHERYLAS for varicose vein (EVLA)
The underlying goal for all thermal ablation procedures is to deliver sufficient thermal energy to the wall of an incompetent vein segment to produce irreversible occlusion, fibrosis, and ultimately disappearance of the vein. The mechanism of vein wall injury after EVLA is controversial. It has been postulated to be mediated both by direct effect and indirectly via laser-induced steam generated by the heating of small amounts of blood within the vein. Adequately damaging the vein wall with thermal energy is imperative to obtain effective ablation. Some heating may occur by direct absorption of photon energy (radiation) by the vein wall, as well as by convection from steam bubbles and conduction from heated blood. However, these later mechanisms are unlikely to account for most of the impact on the vein.
Diode lasers are most commonly used for EVLA. Laser generators exist with multiple different wavelengths, including lower wavelengths that are considered hemoglobin specific and include 810 nm, 940 nm, 980 nm, and 1064 nm. Higher wavelengths are considered water specific and include 1320 nm and 1470 nm. Although it is still not definitively established in the literature, some authors suggest that the higher wavelength lasers produce similar efficacy at lower power settings with less postprocedure symptoms.
It can be performed with multiple different laser fiber designs (ie, bare-tip fibers, jacket-tip fibers [see image below], radial fibers) and diameters available from a variety of vendors. Each of the fiber designs has been demonstrated to be effective in closing the saphenous vein. At this point, there are no conclusive data demonstrating a superiority of a given fiber, wavelength and energy deposition combination, efficacy, significant adverse effects, or complications as metrics for comparison.
Diode lasers are most commonly used for EVLA. Laser generators exist with multiple different wavelengths, including lower wavelengths that are considered hemoglobin specific and include 810 nm, 940 nm, 980 nm, and 1064 nm. Higher wavelengths are considered water specific and include 1320 nm and 1470 nm. Although it is still not definitively established in the literature, some authors suggest that the higher wavelength lasers produce similar efficacy at lower power settings with less postprocedure symptoms.
It can be performed with multiple different laser fiber designs (ie, bare-tip fibers, jacket-tip fibers [see image below], radial fibers) and diameters available from a variety of vendors. Each of the fiber designs has been demonstrated to be effective in closing the saphenous vein. At this point, there are no conclusive data demonstrating a superiority of a given fiber, wavelength and energy deposition combination, efficacy, significant adverse effects, or complications as metrics for comparison.
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