Zhao Man, Yang Dinghui, Shi Jianmin*.
[Abstract] Objective To investigate the clinical application efficacy of laser minimally invasive surgery for the treatment of varicose veins in the lower extremities. Methods Endovenous laser photocoagulation and occlusion of superficial varicose veins in the lower extremities were applied to treat varicose veins in the lower extremities, and the recent and long-term efficacy was further observed. Results All cases treated with the endovenous laser achieved atresia of varicose veins and no recurrence in the short term. Conclusion The efficacy of endovenous laser treatment of varicose veins in the lower extremities was confirmed. Zhao Man, Department of Surgery, Guangdong Workers’ Hospital
【Key words】 Endovenous laser, varicose veins, laser photocoagulation, atresia
Varicose veins of the lower limbs are vascular lesions affecting the superficial venous system of the lower limbs and its branches, manifesting as superficial varicose veins, tortuosity, dilatation, and even trophic changes in the skin of the ankle boot area, which are common clinical conditions. The traditional treatment methods are high ligation of varicose veins and minimally invasive stripping. The surgery is very traumatic and the patient’s postoperative recovery is slow. We are the first to introduce surgical laser therapy instrument in Guangdong Province, and carry out laser minimally invasive surgery to treat superficial varicose veins of lower limbs, which is less traumatic, faster recovery and more effective.
1. Clinical data
1.1. Case selection The cases in this group are all patients with clinically diagnosed superficial varicose veins of lower extremities, including 18 cases with lower extremity skin dystrophy, 38 cases with lower extremity soreness and swelling, and 3 cases with superficial ulcers, aged from 28 to 59 years old, with an average of 45.3 years old.
1.2. Instrument selection Laser therapy instrument name: Surgical Diode Laser Model : FD-30—-A Wavelength 810nm Manufacturer: (Sino-German joint venture) Ling Yun Electronic Company
1.3. Pre-operative preparation After admission, routine laboratory tests, biochemical and functional examination of vital organs, color ultrasound examination of lower extremity veins, lower extremity venography, determination of varicose veins, and the presence of complications
1.4 Surgical procedure
Check whether the laser is normal, connect the fiber, set the parameters: power, pulse mode, set the laser to ready mode, and the red beam appears at the end of the fiber.
Position Supine position
Anesthesia Epidural Local anesthesia General anesthesia is acceptable
Procedure A small incision is made 2 cm below the inguinal ligament on the medial side of the femoral artery in the direction of the dermatome, the subcutaneous tissue is separated and the saphenous vein is found and partially free. The distal end of the saphenous vein is found above the medial ankle, the saphenous vein is punctured with an 18-gauge trocar needle, the core is pushed out after success, the guidewire is placed inside the trocar, the guidewire travels up inside the vein to the ligature, the trocar is withdrawn, the sheath is inserted along the guidewire to the ligature, the guidewire is withdrawn, the laser fiber is inserted through the sheath to the ligature, the red indicator beam at the tip of the fiber can be seen under direct vision, the laser machine is started, and the energy is output while the sheath is withdrawn. The laser machine is activated and the fiber and sheath are withdrawn while the energy is output, and the proximal saphenous vein is compressed at the same time, so that the end of the fiber is in contact with the vessel wall until it is completely withdrawn from the vessel, and the backward speed is generally 0.5–1.0 cm per second. If the varicose vein is large, multiple punctures can be performed. After the procedure, the affected limb is wrapped with an elastic bandage with pressure. Two weeks. 1.5.
1.5. Postoperative precautions Encourage the patient to get out of bed 24 hours after surgery, apply antibiotics for three days, apply pressure bandage for two weeks, avoid strenuous exercise, and review regularly one week, one month, three months, and six months after surgery.
2. results All cases treated by the above methods had varicose vein atresia, no recent revascularization, no traumatic infection, general hospitalization time 2 – 4 days, average about 3 days, good recent efficacy.
3 Discussion Varicose veins of the lower extremities are a common disease, and the mechanism of occurrence is due to weakness of the venous wall, poor function of the venous valves and increased pressure in the superficial veins. The traditional treatment is high ligation and stripping of varicose veins, which is very traumatic, slow recovery and painful for patients. We use endovenous laser treatment, which is less invasive, more effective and faster to recover. The treatment mechanism is based on the application of fiber optics to deliver different wavelengths of infrared laser light inside the vein, which causes indirect thermal damage to the endothelial cells and the vein wall, thus occluding the main trunk of the varicose vein and its branches and eventually forming fibrosis. This minimally invasive technique has many advantages: (1) small incision at the junction of the femoral saphenous vein, which does not increase the difficulty or time of the procedure and does not require postoperative suture removal and is aesthetically pleasing. (2) High ligation of the saphenous vein to prevent the risk of thrombosis. (3) Surgical line puncture with little trauma and no postoperative scars. (4) The treatment range is expanded, and treatment can still be applied even for patients with pacemakers. (5) Definite efficacy. With the development of laser technology, Carlos Bone, a Spanish phlebologist, first reported the application of endovenous laser for the treatment of varicose veins in lower extremities in 1998, and after 1999, some scholars in New York continued to report the initial efficacy of applying this method, and China introduced this technology in Shanghai, Beijing and other places, and carried out successively In 2008, the Department of Health and the Department of Finance of Guangdong Province jointly approved EVLT as a provincial medical application research project, hoping that this technology will be promoted in clinical application as soon as possible.
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