Aim. In varicose vein surgery the scene is completely changed in the last 15 years. Studies on pathophisiology, and also anatomical, state a panorama of clinical-hemodinamic patterns deeply contrary to old single-culture of stripping in all cases. A remarkable new part is emerging with the endo-venous Laser treatment (E-L). An Italian Group participated activelly in the establishment of the International Endovenous-laser Working Group IEWG (1). For reasons of accountability, the members of the Italian Group decided as extremely important to pursue a working programme in which they used the same instruments and a step-by-step protocol. Methods. In a cooperative, multicenter, retrospective clinical study, 1076 patients, mean age of 54.5 years, 241 males and 809 females affected by CVI were considered eligible for surgery and stratified by CEAP classification, in a four-year period (January 1999 – December 2003). In all cases of associated varicosities there was troncular reflux at duplex scan examination. All the patients underwent surgery on the base of clinical-hemodinamic assessment to avoid different surgical indication (Ambulatory phlebectomy, CHIVA, or others). All the centres involved performed the treatment in conformity with FDA validated procedure, using endo-laser venous system kit with 810 (only in the first phase of experience)-980 nm diode laser (ELVeSTM ). Results. In the immediate post-operative period results have been impressive, with very effective closure of incompetent GSV and varicose veins treated (the early occlusion rate has been of 99%), major complications have not been detected: in particular, no DVT evaluated duplex ultrasound, above all considering the elevated medium age of the population. The patient’s compliance and satisfaction to the procedure, measured from appropriate form on quality of life, has been much elevating, equal to 96,7%. No patient has expressed a null compliance to the procedure. At present we have over 6 year results but, in this study and in terms of long-time results, we considered a 36 months follow-up period. Controls have been carried out by duplex scan, according in average to a total medium in relationship to the number of treatments carried out from every centre. The total occlusion rate has been of 97%. Conclusion. Several reports have confirmed the efficacy and safety of E-L, as well as by Perrin’s 2004-review (2), and the same IEWG presented a large experience in the 15th UIP World Congress (3). The present contribution confirms at mid/long-term the «good» result indicating some advantages with standard treatment against a sharing criticism about the no-comparison of many other Laser’s techniques.
|Titolo:||Endo-laser and venous disease Italian group IEWG experience|
AGUS, GIOVANNI BATTISTA (Primo)
|Settore Scientifico Disciplinare:||Settore MED/22 - Chirurgia Vascolare|
|Data di pubblicazione:||2006|
|Appare nelle tipologie:||01 - Articolo su periodico|