Comparison of Endovenous Radiofrequency Versus 810 nm Diode Laser Occlusion of Large Veins in an Animal Model
Comparison of Endovenous Radiofrequency Versus 810 nm Diode Laser Occlusion of Large Veins in an Animal Model
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动物模型中静脉内射频与 810 nm 二极管激光闭塞大静脉的比较
DOI：
10.1046/j.1524-4725.2002.01191.x
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发表时间：
2002
影响因子：
2.4
通讯作者：
R. Weiss
中科院分区：
文献类型：
--
作者：
R. Weiss
背景使用射频（RF）能量的静脉内闭塞已被证明可有效消除隐股静脉返流并随后消除静脉曲张。最近，静脉腔内激光闭塞术已被引入，初步临床报告表明有效治疗静脉曲张。然而，在我们的实践中，我们注意到激光手术的围手术期血肿和压痛增加。关于这种新的激光静脉治疗的作用机制知之甚少。目的通过山羊颈静脉模型，比较腔内激光与腔内射频的作用机制。方法：在3只山羊颈静脉中，使用裸头光纤传输的810 nm二极管激光与使用热电偶（闭合程序）温度反馈回路的工程电极进行的射频输送进行双侧比较。立即和一周的结果进行了研究放射学和组织学。激光治疗期间的温度测量是通过在山羊颈静脉治疗期间使用最多5个热电偶阵列进行的，热电偶间隔2 mm，放置在激光光纤尖端附近。结果组织学检查和造影剂透视检查显示，100%的激光治疗静脉出现穿孔。射频治疗侧显示立即收缩，静脉腔内保持造影剂，无穿孔。急性静脉收缩的差异也很显著，因为激光治疗导致静脉收缩26%，而RF治疗的静脉显示直径急性减小77%。在一周时，急性渗漏到激光治疗静脉周围组织中的外渗血液继续占据空间并撞击周围结构，包括神经。对于激光处理，与激光光纤尖端齐平观察到的最高平均温度为729°C（峰值温度1334°C），而RF方法的温度反馈机制将电极处的温度保持在85°C。结论静脉穿孔，极高的血管内温度，未能引起显着的胶原蛋白收缩，和完整的内皮细胞在动物模型证明了在人类临床应用的810 nm静脉内激光技术的密切关注。理论上，外渗的血液撞击邻近结构可能导致围手术期血肿和压痛增加。需要进一步的研究和临床调查。
BACKGROUND Endovenous occlusion using radiofrequency (RF) energy has been shown to be effective for the elimination of sapheno-femoral reflux and subsequent elimination of varicose veins. Recently, endovenous laser occlusion has been introduced with initial clinical reports indicating effective treatment for varicose veins. However, in our practice we note increased peri-operative hematoma and tenderness with the laser. Little is known regarding the mechanism of action of this new laser vein therapy. OBJECTIVE To better understand the mechanism of action of endovenous laser vs. the endovenous RF procedure in the jugular vein of the goat model. METHODS A bilateral comparison was performed using 810 nm diode laser transmitted by a bare-tipped optical fiber vs. the RF delivery by engineered electrodes with a temperature feedback loop using a thermocouple (Closure procedure) in three goat jugular veins. Immediate and one-week results were studied radiographically and histologically. Temperature measurements during laser treatment were performed by using an array of up to five thermocouples, spaced 2 mm apart, placed adjacent to a laser fiber tip during goat jugular vein treatment. RESULTS Immediate findings showed that 100% of the laser-treated veins showed perforations by histologic examination and immediate contrast fluoroscopy. The RF-treated side showed immediate constriction with maintenance of contrast material within the vein lumen and no perforations. The difference in acute vein shrinkage was also dramatic as laser treatments resulted in vein shrinkage of 26%, while RF-treated veins showed a 77% acute reduction in diameter. At one week, extravasated blood that leaked into the surrounding tissue of laser treated veins acutely, continued to occupy space and impinge on surrounding structures including nerves. For the laser treatment, the highest average temperature was 729°C (peak temperature 1334°C) observed flush with the laser fiber tip, while the temperature feedback mechanism of the RF method maintains temperatures at the electrodes of 85°C. CONCLUSION Vein perforations, extremely high intravascular temperatures, failure to cause significant collagen shrinkage, and intact endothelium in an animal model justify a closer look at the human clinical application of the 810 nm endovenous laser technique. Extravasated blood impinging on adjacent structures may theoretically lead to increased peri-operative hematoma and tenderness. Further study and clinical investigation is warranted.