Intraluminal Venous Laser Treatment

Intraluminal Venous Laser Treatment
 
Intra (inside) Luminal (hole inside the structure) Venous (vein) Laser therapy is a procedure that uses a highly focused beam of light at a particular wave length with all the energy going in the same direction.  The purpose of directing this light is to focus the energy on the vessel and obliterate (destroy) it.  After a doctor determines that a patient has vessel disease by identifying bad, leaky valves within the vessel, a laser apparatus is threaded into a vein.  This will put the laser directly inside the damaged blood vessel and emit a laser beam that will heat and coagulate the vessel.  The laser fiber is then slowly withdrawn as the dilated vessel constricts behind it.  It is important to have an even area of treatment, as the laser is pulled out to be sure we have an even cauterization of the vessel.  This even controlled heat will ensure that the vessel never functions again and the body will absorb it as a foreign burnt protein.  The other desired effect is that blood is pushed back as the laser is retracted so that there is minimal blood left in the vein; this greatly decreases any pigmentation or scarring in the area.
 
Endoluminal lasers are designed for relatively larger deep veins. If the laser is used close to the skin, it can permanently burn and scar the skin.  These lasers are usually used for vessels that are 1 to 1 1/2 inches deep inside the skin.  During the procedure, patients may require tumescent anesthesia to adequately numb the area due to the fact that while the laser fiber is much like an ordinary IV and does not hurt, the energy released when it is activated will heat the vessel to 800 degrees centigrade.  The laser can definitely cause pain and discomfort without anesthesia.  The laser fiber is about the thickness of a paperclip wire.  It is inserted in the area to be treated and is then retracted until the treatment is complete.  The leg and thigh are wrapped with compression bandages for about two days.  All in all, the results are astounding. 
 
There are other methods and different frequencies of laser and radio frequency ablations of veins.  The higher the frequency, the better control, less side effects, and less pain.  Some of the lower frequency lasers and radio ablations (non-laser) are generally outdated and cause more pain, more bleeding, and less permanency of re-canalization or failure of ablation at 1, 3, 5, years than the new higher frequency laser ablation techniques. 
 
Studies are showing again and again that generally, laser techniques are superior to the older radio frequency methods.  In addition, once we turn on our laser, we lock our laser fiber onto a tractor mechanism set at exacting retracting rates to evenly and consistently control our therapy inside the blood vessel.  This eliminates human error.  With other methods, the physician presses and holds the fiber in a treatment area for 5, 10, 15, or 30 seconds then pulls it out manually approximately a certain length, then moves the fiber to the next section to be treated.  I personally prefer only using a laser that "burns" exactly at and from the tip then retracts at specific rates in millimeters (mm) or fractions of millimeters per second for consistency.  The laser fibers I use are tested with a quality assurance technique that assures the end of the fiber is perfectly round, allowing the laser to go forward in a vessel and perfectly coagulate the vessel.
 
A little aberration on the fiber tip can cause a mis-shapen beam of the laser.  What the physician should aim for is a round laser beam.  Any defect of the laser tip will produce something that looks like a comet with a round ball and long tail.  This defective tip can burn and destroy peripheral areas because the tail can burn laterally the tissue, including nerves and other vessels.  More importantly, it can cause permanent nerve damage close to the blood vessels.  I prefer to use a tumescent anesthetic mixed with a small amount of epinephrine which causes not only the desired anesthetic effect but also vasoconstriction of the vessels in order to decrease bleeding and reduce any scarring during and after the procedure.
 
Phlebectomy is the surgical removal of veins through the skin.  This was originally done by making a small cut in the groin area and small cut in the ankle, placing a piano wire through and pulling the vessel out causing tremendous bleeding in the leg due to the leaking communicating branches.  Modern phlebectomy takes vessels close to the skin, making a very small puncture with a scalpel blade every 2 inches along the path, grabbing the vein, and removing it.  With the tumescent anesthesia, there is minimal bleeding even in patients taking blood thinners, and leaves minimal scaring and marks on the skin.  Laser in these areas would permanently scar the skin.  Sclerotherapy for these larger vessels can be very successful in removing these highly convoluted big surface vessels as well.
 
Time is a tremendous friend and healer of the legs in phlebology.  Healing may take days, weeks, or months post-laser, sclerotherapy, or phlebectomy depending on the amount of therapy needed.  They just get better and better with time.  Vein disease and failure of the vein valves, lack of exercise, and genetics make vein disease often a chronic problem.  Newer and better techniques are working to remove pigmentation, blood clots, pain, edema, ulcerations and avoiding amputations.  The healing and results for this, while not perfect, are exceedingly grand.  The results are incredible, beneficial, both cosmetically and for general health.  At the end of these surgical techniques, using sclerotherapy only to remove some of the small veins cannot be overemphasized in regaining the clean, young look of the legs.
 
John Drew Laurusonis, MD
Doctors Medical Center