Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202200481
Jornal Vascular Brasileiro
Innovations

Ablação térmica total assistida: apresentação da técnica ATTA

Assisted total thermal ablation: presentation of the ATTA technique

Daniel Amatuzi; Daniel Autran Burlier Drummond; Douglas Poschinger-Figueiredo; Lucas Barbosa-Silva; Julio Cesar Peclat de Oliveira; Marcos Arêas Marques

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Resumo

Resumo: O tratamento da doença venosa crônica dos membros inferiores evoluiu de forma exponencial nas últimas décadas. Tais avanços permitiram o desenvolvimento de uma proposta de execução técnica sistematizada para o tratamento de ablação endovenosa com laser, a ablação térmica total assistida (ATTA). A técnica propõe um método padronizado de abordagem das veias axiais ou tributárias, varicosas ou inestéticas, de membros inferiores ou outros territórios, em regime ambulatorial ou de hospital-dia. Foram descritos os processos de preparo pré-operatório, marcação detalhada, materiais necessários, acessos venosos, anestesia, cálculo de potência e energia, a técnica de ablação, seguimento e eventos adversos. A ATTA é proposta como uma ferramenta para o tratamento da doença venosa crônica e das veias inestéticas, sugerindo possíveis expansões para as aplicações do laser, além dos troncos venosos, para toda veia passível de ser puncionada.

Palavras-chave

varizes, insuficiência venosa, veia safena, terapia a laser, qualidade de vida, estética

References

1 Laios K. Professor William Wayne Babcock (1872-1963) and his innovations in surgery. Surg Innov. 2018;25(5):536-7. http://dx.doi.org/10.1177/1553350618781618. PMid:29909745.

2 Shortell CK, Markovic JN. Incorporating outpatient venous procedures into a vascular surgery practice. J Vasc Surg. 2009;50(1):225-30. http://dx.doi.org/10.1016/j.jvs.2009.01.063. PMid:19563978.

3 Navarro L, Min RJ, Boné C. Endovenous laser: a new minimally invasive method of treatment for varicose veins--preliminary observations using an 810 nm diode laser. Dermatol Surg. 2001;27(2):117-22. PMid:11207682.

4 Park SW, Yun IJ, Hwang JJ, et al. Endovenous laser ablation of varicose veins after direct percutaneous puncture: early results. Dermatol Surg. 2007;33(10):1243-9. http://dx.doi.org/10.1097/00042728-200710000-00016. PMid:17903158.

5 Hirokawa M, Kurihara N. Comparison of bare-tip and radial fiber in endovenous laser ablation with 1470 nm diode laser. Ann Vasc Dis. 2014;7(3):239-45. http://dx.doi.org/10.3400/avd.oa.14-00081. PMid:25298824.

6 Woźniak W, Mlosek RK, Ciostek P. Complications and failure of endovenous laser ablation and radiofrequency ablation procedures in patients with lower extremity varicose veins in a 5-year follow-up. Vasc Endovascular Surg. 2016;50(7):475-83. http://dx.doi.org/10.1177/1538574416671247. PMid:27681171.

7 Yilmaz S, Ceken K, Alimoglu E, Sindel T. US-guided femoral and sciatic nerve blocks for analgesia during endovenous laser ablation. Cardiovasc Intervent Radiol. 2013;36(1):150-7. http://dx.doi.org/10.1007/s00270-012-0366-4. PMid:22414985.

8 Mii S, Guntani A, Yoshiga R, Matsumoto T, Kawakubo E, Okadome J. Optimal duration of compression stocking therapy after endovenous laser ablation using a 1470-nm diode dual-ring radial laser fiber for great saphenous vein insufficiency. Ann Vasc Dis. 2021;14(2):122-31. http://dx.doi.org/10.3400/avd.oa.21-00012. PMid:34239637.

9 Silva APP, Pinto DM, Milagres VAMV, Bez LG, Maciel JCA, Lopes CS. Resultados do tratamento do refluxo de veias safenas com endolaser 1.470 nm e correlação com o grau de insuficiência venosa. J Vasc Bras. 2021;20:1-7. http://dx.doi.org/10.1590/1677-5449.200172.

10 Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5, Suppl):2S-48S. http://dx.doi.org/10.1016/j.jvs.2011.01.079. PMid:21536172.

11 Wittens C, Davies AH, Bækgaard N, et al. Editor’s Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678-737. http://dx.doi.org/10.1016/j.ejvs.2015.02.007. PMid:25920631.

12 Sociedade Brasileira de Angiologia e de Cirurgia Vascular. [site na Internet]. Projeto Diretrizes SBACV. Insuficiência venosa crônica diagnóstico e tratamento. São Paulo: SBACV; 2015 [citado 2022 mar 17]. https://sbacv.org.br/storage/2018/02/insuficiencia-venosa-cronica.pdf.

13 Vascular Disease Management. [site na Internet]. Nitrous oxide sedation-analgesia in a phlebology practice. Malvern, PA: VDM; 2010 [citado 2022 mar 17]. https://www.hmpgloballearningnetwork.com/site/vdm/content/nitrous-oxide-sedation-analgesia-phlebology-practice

14 van der Geld CWM, van den Bos RR, van Ruijven PWM, Nijsten T, Neumann HA, van Gemert MJ. The heat-pipe resembling action of boiling bubbles in endovenous laser ablation. Lasers Med Sci. 2010;25(6):907-9. http://dx.doi.org/10.1007/s10103-010-0780-2. PMid:20644976.

15 Cohn MS, Seiger E, Goldman S. Ambulatory phlebectomy using the tumescent technique for local anesthesia. Dermatol Surg. 1995;21(4):315-8. http://dx.doi.org/10.1111/j.1524-4725.1995.tb00180.x. PMid:7728482.

16 Dumantepe M, Uyar I. Comparing cold and warm tumescent anesthesia for pain perception during and after the endovenous laser ablation procedure with 1470 nm diode laser. Phlebology. 2015;30(1):45-51. http://dx.doi.org/10.1177/0268355513512827. PMid:24243931.

17 Klein JA. The tumescent technique for lipo-suction surgery. Am J Cosmet Surg. 1987;4(4):263-7. http://dx.doi.org/10.1177/074880688700400403.

18 Shahid KR, Dellon AL, Amrami KK, Spinner RJ. Sciatic and peroneal nerve injuries after endovascular ablation of lower extremity varicosities: case reports and review of the literature. Ann Plast Surg. 2015;74(1):64-8. http://dx.doi.org/10.1097/SAP.0000000000000193. PMid:25072312.

19 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 Fiber 980 nm Laser and Radial-tip Fiber 1470 nm Laser Application. Ann Vasc Surg. 2017;45:166-72. http://dx.doi.org/10.1016/j.avsg.2017.06.042. PMid:28647634.

20 van den Bos RR, Kockaert MA, Neumann HAM, Nijsten T. Technical review of endovenous laser therapy for varicose veins. Eur J Vasc Endovasc Surg. 2008;35(1):88-95. http://dx.doi.org/10.1016/j.ejvs.2007.08.005. PMid:17920307.

21 Ignatieva NY, Zakharkina OL, Masayshvili CV, Maximov SV, Bagratashvili VN, Lunin VV. The role of laser power and pullback velocity in the endovenous laser ablation efficacy: an experimental study. Lasers Med Sci. 2017;32(5):1105-10. http://dx.doi.org/10.1007/s10103-017-2214-x. PMid:28466194.

22 Merchant RF, Pichot O, Closure Study Group. Long-term outcomes of endovenous radiofrequency obliteration of saphenous reflux as a treatment for superficial venous insufficiency. J Vasc Surg. 2005;42(3):502-9, discussion 509. http://dx.doi.org/10.1016/j.jvs.2005.05.007. PMid:16171596.

23 Lurie F, Passman M, Meisner M, et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342-52. http://dx.doi.org/10.1016/j.jvsv.2019.12.075. PMid:32113854.

24 Nayman A, Yildiz I, Koca N, Deniz S, Koplay M, Oguzkurt L. Risk factors associated with recanalization of incompetent saphenous veins treated with radiofrequency ablation catheter. Diagn Interv Imaging. 2017;98(1):29-36. http://dx.doi.org/10.1016/j.diii.2016.06.003. PMid:27373341.

25 Boersma D, Smulders DLJ, Bakker OJ, van den Haak RF, Verhoeven BA, Koning OH. Endovenous laser ablation of insufficient perforating veins: energy is key to success. Vascular. 2016;24(2):144-9. http://dx.doi.org/10.1177/1708538115587214. PMid:25972028.

26 Bakker NA, Schieven LW, Bruins RMG, van den Berg M, Hissink RJ. Compression stockings after endovenous laser ablation of the great saphenous vein: a prospective randomized controlled trial. Eur J Vasc Endovasc Surg. 2013;46(5):588-92. http://dx.doi.org/10.1016/j.ejvs.2013.08.001. PMid:24012465.

27 Dexter D, Kabnick L, Berland T, et al. Complications of endovenous lasers. Phlebology. 2012;27(Suppl 1):40-5. http://dx.doi.org/10.1258/phleb.2012.012s18. PMid:22312066.

28 Poschinger-Figueiredo D, Virgini-Magalhães CE, Porto LC, et al. Radiofrequency ablation for axial reflux associated with foam sclerotherapy for varicosities in one-step approach: a prospective cohort study comprising large diameters saphenous veins. Vasc Health Risk Manag. 2021;17:379-87. http://dx.doi.org/10.2147/VHRM.S313282. PMid:34239304.

29 Lee BB, Nicolaides AN, Myers K, et al. Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence. Int Angiol. 2016;35(3):236-352. PMid:27013029.

30 Kabnick LS, Ombrellino M. Ambulatory phlebectomy. Semin Intervent Radiol. 2005;22(3):218-24. http://dx.doi.org/10.1055/s-2005-921955. PMid:21326696.
 


Submitted date:
04/15/2022

Accepted date:
08/25/2022

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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