WHAT IS NEW IN ENDOVENOUS LASER 2009 :WHAT IS NEW IN ENDOVENOUS LASER 2009 Mr.Mohamed Omar El-Farok,M.Sc, FRCS(Eng,Ed)


Topics to be covered :Topics to be covered What is the best laser wavelength What is the best laser fiber How to calculate laser energy The new tool for varicose veins 2009 (MEECA) and (RIFTT)


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


FIRST PUBLICATION OF RADIOFREQUENCY :FIRST PUBLICATION OF RADIOFREQUENCY By :Chandler JG Title :Treatment of primary venous insufficiency by endovenous saphenous vein obliteration . J Vasc Surg 2000; 34: 201-1


HERE WE HAVE :HERE WE HAVE Two new techniques developed at the same time and technology pushing both of them What happened ?


US Varicose Vein Procedures (000) :Sources: Millennium Research Group, Nov 2005 & MedTech Insight, Oct 7, 2005 US Varicose Vein Procedures (000) SURG RF LASER


What is the best wavelength 2009 ? :What is the best wavelength 2009 ? Does it matters ? Yes It means more effective in less time with less tissue damage


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 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 :


Laser Diode 980 nm : optimum wave lengh :Laser Diode 980 nm : optimum wave lengh


DIODE 980 - 1470 :DIODE 980 - 1470


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 :15 STANDARD LASER CATHETER


STANDARD LASER FIBERS :STANDARD LASER FIBERS OPTICAL FIBER 600 u


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


Pain score :Pain score


EVOLUTION OF POST-OP PAIN :EVOLUTION OF POST-OP PAIN


INDICATIONS FOR EVLT :22 INDICATIONS FOR EVLT Varicose vein (with or without SF-SP junction insufficiency) Truncal varicose veins Large branch veins Large tributaries All veins that are not extremely tortous Perforator veins insufficiency


CONTRAINDICATIONS FOR EVLT :23 CONTRAINDICATIONS FOR EVLT Active thrombophlebitis or DVT Infection or inflamation area intended to be treated Febrile state


POSSIBLE SIDE EFFECTS :24 POSSIBLE SIDE EFFECTS Bruising, Soreness (up to 3 – 5 days), Nonspecific inflamatory response (thermal effect), Skin burn, Infection, Oedema, Discoloration, Paresthesia, Erythema, Vein perforation, Thrombophlebitis or DVT


TREATMENT PARAMETERS USED FOR EVLT WITH FOTONA XP-2 :25 TREATMENT PARAMETERS USED FOR EVLT WITH FOTONA XP-2


CALCULATION OF LASER :CALCULATION OF LASER Minimum Energy /cm = 10 joules /cm /diameter in mm of vein to be treated (Controversies in varicose desease Paris january 2007)


Calculate the energy before beginning :Calculate the energy before beginning Minimum energy : SFJ : 12 mm x 10 = 120 joules/cm Thigh: 6mm x 10 = 60 joules /cm Length to be treated 40 cm 60 joules x 40 cm = 2400 joules


Endolaser :Endolaser DISAVANTAGES Different wavelengths Energy dose By your own Dependant on pullback speed ADVANTAGES Efficient : more than 95% Adapt energy according size of the vein Adapt energy according depth of the vein Less painful less ecchymosis with 360 and 1470 nm


EBM on Endo-Laser :EBM on Endo-Laser Currently 82 articles have been published in English (68) and French (14) on RF obliteration and EVLT for treating varicose veins. Nineteen of them compared RF versus EVLT but no RCT. Seven compared RF versus HL + Stripping +/Stab Avulsion including 4 RCT One compared RF, EVL, L+stripping


Slide 30:So this is laser


Any thing new :Any thing new Yes


Veins Profitable Business :Veins Profitable Business Revenues close to $50 million in 2011 Gross margin of 80% Independent investment report suggests a $350 million revenue business


“mechanically enhanced endovenous chemical ablation”MEECA :“mechanically enhanced endovenous chemical ablation”MEECA Small-caliber infusion catheter used to increase the effectiveness of a sclerosing agent by delivering the agent to the vein wall while simultaneously inducing spasm and irritating and destroying the endothelium to ablate diseased veins in place in a few minutes.


Slide 34:† Mechanically enhanced endovenous chemical ablation (MEECA)


Slide 35:Bipolar Radiofrequency induced Thermotherapy (RFITT®) A minimally invasive procedure for v v.


Slide 36:THANK YOU