Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles.
Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles.
复制标题
使用 940 nm 二极管激光对大隐静脉进行静脉内治疗：激光产生的蒸汽泡造成腔内热损伤后血栓闭塞。
DOI：
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发表时间：
2002
影响因子：
4.3
通讯作者：
Juergen Knop
中科院分区：
文献类型：
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作者：
T. Proebstle;H. Lehr;A. Kargl;C. Espinola;W. Rother;S. Bethge;Juergen Knop
目的
尽管该技术的快速传播，很少有人知道静脉腔内激光治疗（EVLT）的激光-组织相互作用。我们评价了EVLT治疗功能不全的大隐静脉（GSV）的疗效、治疗相关的不良反应和假定的作用机制。
方法
选择2 - 6例31条肢体，临床分期为C（2-6）、E（P）、A（S，P）、P（R），经双功扫描证实GSV功能不全的患者，在门诊接受EVLT。通过膝关节下方的18号针将600 μ m纤维进入GSV，并继续进入隐股关节（SFJ）。肿胀局部麻醉浸润后，以标准化方式沿静脉沿着给予15 J能量和940 nm波长的多个激光脉冲。在16例患者完成EVLT后30分钟和20例患者术后第1天测定外周血样本中的D-二聚体。通过组织病理学检查EVLT后手术切除的一个GSV。此外，一个实验在体外设置被构造为一种手段，调查的机制，在充满血液的管中的激光作用。
结果
沿治疗静脉沿着施加中值为80个激光脉冲（范围，22-116个激光脉冲）。在第1、7和28天，除1条肢体（97%）外，所有肢体均显示GSV血栓闭塞。1例患者的血管显示不完全闭塞。其余患者血栓近端至SFJ的距离中位数为1.1 cm（范围：0.2-5.9 cm）。所有26例患者的不良反应均为瘀斑和沿血栓闭塞的GSV沿着可触及的硬结，持续2 ~ 3周。在两条肢体（6%）中，静脉曲张分支的血栓性静脉炎需要口服双氯芬酸治疗。外周血中的D-二聚体在完成手术后30分钟在16名患者中的14名中检测结果正常，在EVLT后第1天在20名患者中的7名中检测结果升高。然而，在EVLT后30分钟和第1天接受测试的16名患者中，有15名患者的D-二聚体从第0天到第1天增加。通过离体实验和组织病理学检查，证明940 nm激光通过间接热损伤内静脉壁发挥作用。
结论
用940 nm二极管激光对GSV进行EVLT可有效诱导血栓性血管闭塞，且仅与轻微不良反应相关。激光引起的局部热损伤的内静脉壁的蒸汽气泡起源于沸腾的血液被提出作为EVLT的作用的病理生理机制。
PURPOSE
Despite a rapid spread of the technique, very little is known about the laser-tissue interaction in endovenous laser treatment (EVLT). We evaluated EVLT of the incompetent greater saphenous vein (GSV) for efficacy, treatment-related adverse effects, and putative mechanisms of action.
METHODS
Twenty-six patients with 31 limbs of clinical stages C(2-6), E(P), A(S,P), P(R) with incompetent GSV proven by means of duplex scanning were selected for EVLT in an outpatient setting. A 600-microm fiber was entered into the GSV via an 18-gauge needle below the knee and proceeded to the saphenofemoral junction (SFJ). After infiltration of tumescent local anesthesia, multiple laser pulses of 15 J energy and a wavelength of 940 nm were administered along the vein in a standardized fashion. D-dimers were determined in peripheral blood samples 30 minutes after completion of EVLT in 16 patients and on postoperative day 1 in 20 patients. One GSV that was surgically removed after EVLT was examined by means of histopathology. Additionally, an experimental in vitro set-up was constructed as a means of investigating the mechanism of laser action within a blood-filled tube.
RESULTS
A median of 80 laser pulses (range, 22-116 laser pulses) were applied along the treated veins. On days 1, 7, and 28, all limbs except one (97%) showed a thrombotically occluded GSV. In one patient, the vessel showed incomplete occlusion. The distance of the proximal end of the thrombus to the SFJ was a median 1.1 cm (range, 0.2-5.9 cm) in the remaining patients. Adverse effects in all 26 patients were ecchymoses and palpable induration along the thrombotically occluded GSV that lasted for 2 to 3 weeks. In two limbs (6%), thrombophlebitis of a varicose tributary required oral treatment with diclofenac. D-dimers in peripheral blood were tested with normal results in 14 of 16 patients 30 minutes after completion of the procedure and elevated results in 7 of 20 patients at day 1 after EVLT. However, an increase of D-dimers from day 0 to day 1 was observed in 15 of the 16 patients undergoing tests 30 minutes after EVLT and on day 1. The 940-nm laser was demonstrated by means of in vitro experiments and the histopathological examination of one explanted GSV to act by means of indirect heat damage of the inner vein wall.
CONCLUSION
EVLT of the GSV with a 940-nm diode laser is effective in inducing thrombotic vessel occlusion and is associated with only minor adverse effects. Laser-induced indirect local heat injury of the inner vein wall by steam bubbles originating from boiling blood is proposed as the pathophysiological mechanism of action of EVLT.