EVLT value and limitations

EVLT value and limitations: 

EVLT value and limitations Mr. Mohamed Omar El- Farok , M.Sc , FRCSENG, FRCSED

Topics to be covered : 

Topics to be covered First publication of EVLT Number of Varicose veins procedures in the US What is EVLT What is the best type of Laser so far How laser works and the best laser fiber What to offer to your patient ? Can be EVLT the most cost effective procedure ?

FIRST PUBLICATION OF ENDOVENOUS LASER : 

FIRST PUBLICATION OF ENDOVENOUS LASER Title : Endovenous laser : a new minimally invasive method of treatment for varicose veins- preliminary observations using an 810 nm diode laser . Dermato Surg 2001; 27 : 117-122

US Varicose Vein Procedures (000): 

350 300 250 200 150 100 50 0 2003 2004 2005 2006 2007 2008 2009 2010 Sources: Millennium Research Group, Nov 2005 & MedTech Insight, Oct 7, 2005 US Varicose Vein Procedures (000) SURG RF LASER

Slide 5: 

What is EVLT ?

Slide 6: 

What is the EVLT Procedure ? EVLT is a relatively new minimally invasive treatment for varicose veins. EVLT uses a laser that has been fit with a laser fiber tip which is used to introduce light energy into the diseased vein. The light energy, in turn, damages the inner vein wall, causing the collagen fibers to contract and the vein to collapse. An emphasis will made as to the efficacy of EVLT to successfully treat great saphenous vein (GSV) reflux due to incompetence at the saphenofemoral junction (SFJ), “the underlying cause in 80 percent of patients with significant varicose veins.”

Slide 7: 

After the EVLT Before EVLT

WHAT IS AVAILABLE WAVE LENGTHS: 

WHAT IS AVAILABLE WAVE LENGTHS 1064nm DROPPED 810nm DROPPED 940nm 980nm NEW 1320 NEW 1470 the best so far

HOW EVLT WORKS: 

9 VEIN WALL CATHETER FIBER BLOOD LASER BEAM HEATING HEATING HEATING INTERACTION GEOMETRY HOW EVLT WORKS

Tissue Ablation: 

Tissue Ablation 10 C – 45 C: Conformation change of proteins 50 C: Reduction of enzyme activity 60 C: Denaturation 100 C: Water vaporizes Thermal damage

LASER ABSORPTION :: 

LASER ABSORPTION :

WHAT IS NEW IN LASER FIBERS :: 

WHAT IS NEW IN LASER FIBERS : Does fiber matters ? Yes Better fiber cover more area in less time with less complications and less pain

STANDARD LASER CATHETER: 

13 STANDARD LASER CATHETER

1- Bare fiber: 

1- Bare fiber

2-Jacket tip versus bare tip: 

2-Jacket tip versus bare tip

3-New 360 degree fiber: 

3-New 360 degree fiber

What to offer to your patient ?: 

What to offer to your patient ? Varicose veins surgery EVLT EVRF Conservative Foam sclerotheapy

What every one’s want ?: 

What every one’s want ? Hospital Manager Patient Junior staff ?

Search in PubMed: 

Search in PubMed Varicose veins 15 232 Treatment 10 307 Surgery 6 856 RCT 393 Economy 28 Ethics 2 Economy + ethics 0

Slide 20: 

If health care costs and reimbursement systems favour treatment of certain groups of patients for other reasons than medical - this is unethical Ethical rule

Basic normative ethics: 

Basic normative ethics to do good not to harm respect autonomy respect justice/equity

EVLT: 

EVLT Has always been blamed to be expensive alternative to varicose vein surgery Can it be cheaper ?

How to calculate cost of a procedure: 

How to calculate cost of a procedure Cost of procedure Total cost of procedure x Recurrence rate Total Cost

How to calculate cost: 

How to calculate cost Information on probability from: Medical Services Advisory Committee, Endovenous laser therapy (ELT) for varicose veins. MSAC application 1113, Dept of Health and Ageing, Commonwealth of Australia, 2008. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/2E0BACBB8704139ACA25745E001C2F21/$File/1113report.pdf Repeat Procedure

Some definitions :: 

Some definitions : An ICER under 20,000 GBP makes a new technology cost-effective according to UK NICE guidelines (Gohel et al., 2010) -QALYs = Quality Adjusted Life years -ICER = incremental cost effectiveness ratio .

Slide 26: 

- Compate cost of 8 popular management strategy of varicose veins with 5 years follow-up

What are these 8 strategy :: 

What are these 8 strategy :

Results : 

Results

Conclusion :: 

Conclusion : The Endovenous laser technology is becoming more standarized EVLT is becoming on of the most cost effective procedure in management of Varicose veins Ethics and cost efficiency are very important parameter for all our peripheral vascular practice

Advise : 

Advise In recent years we have seen technology advance at lightening speed allowing Us to accomplish lifesaving feats never imagined before . It is our responsibility to ensure that these advances are used for positive medical Breakthroughs and not to allowed to restrict Rights or limit access to health insurance of job Opportunities By Evan Bayh Quotes (US Senator from Indiana 1999-2010)

Thank You: 

Thank You