VARICOSE VEINS
LASER
Introduction
Last updated: apr 5, 2023
- Prevalence > 20% in Western population
- 5% suffer from venous edema, skin changes or ulcerations
- 0.5% active ulcers : 1.4% healed ulcers
Indications
- Clinical symptoms
- Aching
- Throbbing
- Heaviness
- Fatigue
- Pruritus
- Night cramps
- Restlessness
- Generalized pain
- Swelling
- Objective reflux
- 1 s reversed flow femoral or popliteal vein
- Deep femoral and perforating veins
- Perforators with a diameter > 3.5 mm
- Perforators located underneath an ulcer
- Refluxtijd ≥ 500ms (perforatoren ≥ 350ms)
Contra indications
Absolute
- Deep vein thrombosis (DVT) in the past six months (caution for deep venous obstruction with secondary varices essential for venous drainage)
- Acute superficial thrombophlebitis and migratory phlebitis
- Allergy to acrylate (type 4 hypersensitivity)
- Arterial insufficiency in Fontaine stages III and IV (Stage III marked by rest and nighttime pain; Stage IV with continuous pain and acral ulcerations). For arterial issues, adequate compression—crucial in sclerotherapy—cannot be used.
- Severe systemic illnesses, especially those involving bed confinement (acute infections, liver or kidney dysfunctions, neoplasms, severe chronic cardiac or respiratory diseases)
- Immobility due to musculoskeletal issues (typically accompanied by edema, intolerance to adequate compression, increased risk of thrombosis)
- Pregnancy and breastfeeding: Varices are typically not sclerosed during pregnancy as aethoxysclerol lacks a "safe during pregnancy" label. Veins often revert to normal size 8–10 weeks postpartum. If symptomatic, treatment is better scheduled prior to a subsequent pregnancy to prevent progression.
Relative
- History of recurrent DVT
- Clotting disorders with hypercoagulability
- Anticoagulant use
- Severe edema
- Complicating arteriosclerosis with risk of pressure necrosis
- Angiodysplasia, such as varices associated with Klippel-Trénaunay syndrome, where Duplex ultrasound should exclude deep vein anomalies
- Patient unable or unwilling to wear compression stockings
Materials
Essentials
- Sterile drape and square adhesive dressing
- Ultrasound device with gel and sterile cover
- Puncture needle and 5Fr sheath
- Tumescent fluid (500 ml NaCl 0.9% with 25 ml Lidocaine 2% without adrenaline)
- Infiltration pump with foot pedal, infusion system, and yellow needle (20G)
- Laser device
Non-Essentials
The procedure in steps
TOP
Setup
- Sterile draping according to protocol
- Plug power cord into wall socket.
- Connect the door interlock switch and foot pedal (back of device).
- Turn on the power switch at the back of the device.
- Insert the key on the front and turn it a quarter turn. Wait for the self-test to complete.
- Press the center button to continue.
- When prompted, insert the fiber, plug it in, and secure it. A check mark will appear on the screen.
- The screen will automatically advance to confirm that the fiber is valid. Confirm by pressing the center button.
- Continue pressing the center button as prompted until you see:
- EVLT Continuous
- Continue (highlighted in light blue)
- Statistics
- Configuration screen
- The display will now show:
- Power: 7.0 W
- Confirm (highlighted) | Back
- Press the center button to confirm. The laser is now ready for use.
Ablation Procedure
- Ensure everyone, including the patient, is wearing protective glasses.
- Position the foot pedal.
- Activate the pedal by pressing the right button on the device.
- To end the procedure, press the right button again and remove the foot pedal.
Data Logging
- Remove the fiber from the device.
- Turn the center knob to "Statistics" and confirm.
- Turn the knob to "Current Statistics" and confirm.
- Record patient ID, time in seconds, and Joules used.
If Starting a New Procedure
- Press "Back"; the laser is ready for the next session.
- When completely finished, turn the key, remove the power cord, and store adapters.
SOP
Report
Time out. Positioneren patient. Been wordt gedesinfecteerd, liesstreek goed mee desinfecteren. Na desinfecteren steriel afdekken. Onder echo aanprikken van de VSM rechts. Over-the-wire invoeren van de sheath, en opvoeren van de LASER tot aan de crosse. Inbrengen van tumescentie. 500 ml NaCl 0,9%met 25 ml Lidocaine 2% zonder adrenaline. Vervolgens ablatie van de vene. Hemostase. Compressie kous. Sign-out.
