Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.200244
Jornal Vascular Brasileiro
Original Article

Uso do laser de 1.470 nm para o tratamento de insuficiência venosa superficial

Use of 1,470 nm laser for treatment of superficial venous insufficiency

Manuella Bernardo Ferreira; Gilberto do Nascimento Galego; Nazaré Otília Nazário; Rafael Narciso Franklin; Pierre Galvagni Silveira; Cristiano Torres Bortoluzzi; Daniel Ishikawa; Fernando Wolf

Downloads: 0
Views: 53

Resumo

Resumo: Contexto: Existem diversas formas de tratamento de varizes de membros inferiores. Entre elas, destaca-se o uso do laser diodo de 1.470 nm. Essa técnica proporciona aos pacientes uma cirurgia em regime ambulatorial, com retorno precoce à atividade ocupacional, bom resultado estético e baixo índice de complicações. No entanto, ainda se discute exaustivamente variáveis como comprimento de onda do laser, potência aplicada em cada área, tipo de fibra, necessidade ou não de tumescência e densidade de energia endovenosa linear.

Objetivos: Analisar os resultados do tratamento da insuficiência venosa superficial com laser diodo de 1.470 nm.

Métodos: Estudo retrospectivo, realizado em uma clínica privada de um hospital privado em Florianópolis a partir de dados colhidos prospectivamente. As amostras eram de 287 pacientes submetidos à cirurgia para tratamento da insuficiência venosa superficial com laser diodo de 1.470 nm, de janeiro de 2016 a dezembro de 2018, totalizando 358 veias safenas magnas e 84 veias safenas parvas tratadas.

Resultados: A taxa de oclusão total após 12 meses de cirurgia foi de 94,4%, com densidade de energia endovenosa linear média de 45,90 J/cm nas veias safenas magnas e de 96,4% com densidade de energia endovenosa linear média de 44,07 J/cm nas veias safenas parvas.

Conclusões: No período acompanhado, o laser diodo de 1.470 nm mostrou-se um tratamento seguro, muito efetivo e com baixas taxas de complicações (dor, edema, equimose, trombose venosa profunda e trombose induzida pelo calor endovenoso).

Palavras-chave

insuficiência venosa, varizes, angioplastia a laser, técnicas de ablação

Abstract

Background: There are several ways to treat varicose veins of the lower limbs, among which use of 1470nm diode lasers stands out. This technique can be used to treat patients in outpatient settings, with early return to work, good esthetic results, and low rates of complications. However, variables such as the laser wavelength, the power administered in each area, the type of fiber, and the linear intravenous energy density (LEED) are still extensively discussed. Objectives: To analyze the results of superficial venous insufficiency treatment with a 1470nm diode laser. Methods: Retrospective study conducted at a private clinic in a private hospital in Florianopolis, based on a database collected prospectively. The sample comprised 287 patients who underwent surgery to treat superficial venous insufficiency with 1470nm diode laser, from January 2016 to December 2018, totaling 358 great saphenous veins (GSVs) and 84 small saphenous veins (SSVs) treated. Results: The total occlusion rates after 12 months of surgery were 94.4% in the GSVs, with an average LEED of 45.90 J/cm, and 96.4% in the SSVs, with an average LEED of 44.07 J/cm. Conclusions: During the follow-up period, the 1470nm diode laser proved to be a safe treatment, with great efficacy and low rates of complications (pain, edema, bruising, deep vein thrombosis, and endothermal heat-induced thrombosis - EHIT).

Keywords

venous insufficiency; varicose veins; laser angioplasty; intravenous ablation.

References

1 Sociedade Brasileira de Angiologia e Cirurgia Vascular. Insuficiência Venosa Crônica Diagnóstico e Tratamento [Internet]. [cited 2020 Mar 2]. https://www.sbacv.org.br/lib/media/pdf/diretrizes/insuficiencia-venosa-cronica.pdf.

2 Valenciano LPR, Fonseca HE, Sánchez PC, Bermúdez JG. Generalidades das varizes em membros inferiores e seu tratamento durante a gravidez: uma revisão narrativa. J Vasc Bras. 2010;9(2):29-35.

3 Lins EM, Barros JW, Appolônio F, Lima EC, Junior MB, Anacleto E. Perfil epidemiológico de pacientes submetidos a tratamento cirúrgico de varizes de membros inferiores. J Vasc Bras. 2012;11(4):301-4. http://dx.doi.org/10.1590/S1677-54492012000400008.

4 Mallick R, Lal BK, Daugherty C. Relationship between patient-reported symptoms, limitations in daily activities, and psychological impact in varicose veins. J Vasc Surg Venous Lymphat Disord. 2017;5(2):224-37. http://dx.doi.org/10.1016/j.jvsv.2016.11.004. PMid:28214491.

5 Yümün HNA, Gür O, Gürkan S. Comparison of 1470 nm Radial Fiber Laser Ablation and Radiofrequency Ablation in Endovascular Treatment of Venous Insufficiency. WJCS. 2016;6(9):117-24. http://dx.doi.org/10.4236/wjcs.2016.69019.

6 Seidel AC, Campos MB, Campos RB, et al. Associação entre sintomas, veias varicosas e refluxo na veia safena magna ao eco-Doppler. J Vasc Bras. 2017;16(1):4-10. http://dx.doi.org/10.1590/1677-5449.005216. PMid:29930616.

7 Rossi FH, Volpato MG, Metzger PB, et al. Estudo da relação entre a gravidade dos sinais, dos sintomas e da qualidade de vida em pacientes portadores de doença venosa crônica. J Vasc Bras. 2015;14(1):22-8. http://dx.doi.org/10.1590/1677-5449.20140039.

8 Maffei FHA, Lastória S, Yoshida WB, Rollo HA. Doenças Vasculares Periféricas. 4. ed. Rio de Janeiro: Guanabara Koogan; 2008. 2135 p.

9 Sacchi AA, Castro AA, Pitta GBB, Miranda Junior F. Pitta GBB, Miranda Jr G. Avaliação da bomba muscular da panturrilha em pacientes portadores de varizes primárias dos membros inferiores através da pletismografia a ar. J Vasc Bras. 2007;6(1):25-34. http://dx.doi.org/10.1590/S1677-54492007000100005.

10 Erzinger FL, de Araujo WJB, Nejm CS, Caron FC, Timi JRR. Estudo comparativo da termoablação da veia safena magna na coxa, com e sem tumescência. J Vasc Bras. 2016;15(3):217-23. http://dx.doi.org/10.1590/1677-5449.004616. PMid:29930593.

11 Murad MH, Coto-Yglesias F, Zumaeta-Garcia M, et al. A systematic review and meta-analysis of the treatments of varicose veins. J Vasc Surg. 2011;53(5, Suppl.):49-65. http://dx.doi.org/10.1016/j.jvs.2011.02.031. PMid:21536173.

12 Nesbitt C, Bedenis R, Bhattacharya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Sao Paulo Med J. 2014;132(1):69-9. http://dx.doi.org/10.1590/1516-3180.20141321T2. PMid:24474085.

13 Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc Interv Radiol. 2003;14(8):991-6. http://dx.doi.org/10.1097/01.RVI.0000082864.05622.E4. PMid:12902556.

14 Berridge D, Bradbury AW, Davies AH, et al. Recommendations for the referral and treatment of patients with lower limb chronic venous insufficiency (including varicose veins). Phlebology. 2011;26(3):91-3. http://dx.doi.org/10.1258/phleb.2011.011g01. PMid:21471582.

15 Mundy L, Merlin TL, Fitridge RA, Hiller JE. Systematic review of endovenous laser treatment for varicose veins. Br J Surg. 2005;92(10):1189-94. http://dx.doi.org/10.1002/bjs.5142. PMid:16175538.

16 Oliveira RA, Mazzucca ACP, Pachito DV, Riera R, Baptista-Silva J. Evidence for varicose vein treatment: an overview of systematic reviews. Sao Paulo Med J. 2018;136(4):324-32. http://dx.doi.org/10.1590/1516-3180.2018.0003240418. PMid:30020324.

17 Malskat WSJ, Engels LK, Hollestein LM, Nijsten T, Van den Bos RR. Commonly Used Endovenous Laser Ablation (EVLA) Parameters Do Not Influence Efficacy: Results of a Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2019;58(2):230-42. http://dx.doi.org/10.1016/j.ejvs.2018.10.036. PMid:31230868.

18 Steyaert A, Letter JD, Lanckneus M, Reusens H. Endovenous Laser Ablation of the Great Saphenous Vein with a 1470 nm Wavelength Laser: Results of a Prospective, Single Centre Cohort Study. Acta Chir Belg. 2014;114(4):256-60. http://dx.doi.org/10.1080/00015458.2014.11681022. PMid:26021421.

19 Van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T. Endovenous therapies of lower extremity varicosities: A meta-analysis. J Vasc Surg. 2009;49(1):230-9. http://dx.doi.org/10.1016/j.jvs.2008.06.030. PMid:18692348.

20 Cartão do SUS [site na Internet]. Tratamento de varizes com espuma pelo SUS: Veja como conseguir [cited 2020 Apr 17]. https://cartaodosus.info/tratamento-de-varizes-pelo-sus/.

21 Viarengo LMA, Viarengo G, Martins A, Mancini MW, Lopes LA. Resultados de médio e longo prazo do tratamento endovenoso de varizes com laser de diodo em 1940 nm: análise crítica e considerações técnicas. J Vasc Bras. 2017;16(1):23-30. http://dx.doi.org/10.1590/1677-5449.010116. PMid:29930619.

22 Stokbroekx T, de Boer A, Verdaasdonk RM, Vuylsteke ME, Mordon SR. Commonly used fiber tips in endovenous laser ablation (EVLA): an analysis of technical differences. Lasers Med Sci. 2014;29(2):501-7. http://dx.doi.org/10.1007/s10103-013-1475-2. PMid:24338133.

23 Galego GN, Lima GBB, Franklin RN, Bortoluzzi CT, Silveira PG. Resultado do tratamento da insuficiência venosa superficial com Laser Diodo 1470 nm. J Vasc Bras. 2015;14(2):115-22. http://dx.doi.org/10.1590/1677-5449.0073.

24 Hirokawa M, Ogawa T, Sugawara H, Shokoku S, Sato S. Comparison of 1470 nm Laser and Radial 2ring Fiber with 980 nm Laser and Bare-Tip Fiber in endovenous laser ablation of saphenous varicose veins: a multicenter, prospective, randomized, non-blind study. Ann Vasc Dis. 2015;8(4):282-9. http://dx.doi.org/10.3400/avd.oa.15-00084. PMid:26730252.

25 Doganci S, Demirkilic U. Comparison of 980 nm laser and bare-tip fibre with 1470 nm laser and radial fibre in the treatment of great saphenous vein varicosities: a prospective randomised clinical trial. Eur J Vasc Endovasc Surg. 2010;40(2):254-9. http://dx.doi.org/10.1016/j.ejvs.2010.04.006. PMid:20547079.

26 Arslan Ü, Çalık E, Tort M, et al. More Successful Results with Less Energy in Endovenous Laser Ablation Treatment: Long-term Comparison of Bare-tip Fiber980nm Laser and Radial-tip Fiber1470nm Laser Application. Ann Vasc Surg. 2017;45(1):166-72. http://dx.doi.org/10.1016/j.avsg.2017.06.042. PMid:28647634.

27 Galanopoulos G, Lambidis C. Minimally invasive treatment of varicose veins: endovenous laser ablation (EVLA). Int J Surg. 2012;10(3):134-9. http://dx.doi.org/10.1016/j.ijsu.2012.02.013. PMid:22373866.

28 Park JA, Park SW, Chang IS, et al. The 1,470-nm bare-fiber diode laser ablation of the great saphenous vein and small saphenous vein at 1-year follow-up using 8-12 W and a mean linear endovenous energy density of 72 J/cm. J Vasc Interv Radiol. 2014;25(11):1795-800. http://dx.doi.org/10.1016/j.jvir.2014.07.009. PMid:25156646.

29 Proebstle TM, Moehler T, Gul D, Herdemann S. Endovenous treatment of the great saphenous vein using a 1320 nm Nd:YAG laser causes fewer side effects than using a 940 nm diode laser. Dermatol Surg. 2005;31(1):1678-83. PMid:16336887.

30 Van den Bos RR, Neumann M, de Roos KP, Nijsten T. Endovenous Laser Ablation–Induced Complications: Review of the Literature and New Cases. Dermatol Surg. 2009;35(8):1678-84. http://dx.doi.org/10.1111/j.1524-4725.2009.01215.x. PMid:19469796.

31 Abu-Elcibaa O, El-Hamed EAA, Abd EMM. Management of primary uncomplicated varicose veins, endovenous laser ablation with sclerotherapy versus traditional surgery: which is the best option? Egypt J Surg. 2019;38(2):319-27.

32 Osborne NR, Anastakis DJ, Davis KD. Peripheral nerve injuries, pain, and neuroplasticity. J Hand Ther. 2018;31(2):184-94. http://dx.doi.org/10.1016/j.jht.2018.01.011. PMid:29706196.

33 Ahadiat O, Higgins S, Ly A, Nazemi A, Wysong A. Review of Endovenous thermal ablation of the great saphenous vein. Dermatol Surg. 2018;44(5):679-88. http://dx.doi.org/10.1097/DSS.0000000000001478. PMid:29462021.

34 Sadek M, Kabnick LS, Rockman CB, et al. Increasing ablation distance peripheral to the saphenofemoral junction may result in a diminished rate of endothermal heat-induced thrombosis. J Vasc Surg. 2013;1(3):257-62. PMid:26992584.

35 Kane K, Fisher T, Bennett M, et al. The incidence and outcome of endothermal heat-induced thrombosis after endovenous laser ablation. Ann Vasc Surg. 2014;28(7):1744-50. http://dx.doi.org/10.1016/j.avsg.2014.05.005. PMid:24911803.
 


Submitted date:
12/28/2020

Accepted date:
04/12/2021

60d4c3e7a95395608a634215 jvb Articles

J Vasc Bras

Share this page
Page Sections