Varicose Veins(EVLT)

1.What are varicose veins

Varicose veins are a disease caused by stagnation of blood and weakness of the walls of the veins, which manifests as tortuous dilatation of the veins. Common types of varicose veins include varicose veins of the lower extremities,fundic-esophageal varicose veins, varicose veins of the spermatic cord, and superficial varicose veins of the abdominal wall.

2.Diagnostic grading criteria for venous disease

3.The surgical treatment process of laser therapy for varicose veins(EVLT)

Pre-operative Preparation & Surgical Procedure:

3.1 Imaging check

Venous ultrasound: to determine thr veins diameter,direction of the blood flow, reflux time, etc;to eliminate deep vein thrombosis, vascular malformations, etc.

Venography: to further define the veins and exclude contraindications.

3.2 Preoperative marking

The patient is placed in an upright position for a few minutes, or a tourniquet is applied to the base of the thigh to inflate the superficial varicose vein, and the course of the varicose vein is marked with a double line, and ultrasound is used to confirm vein diameter, location, and blood flow if necessary.

3.3 Anesthesia and position

Under anesthesiologist supervision, mild intravenous sedation with isoproterenol or midazolam, with the option of local infiltration, subarachnoid/epidural block anesthesia.

Routinely sterilize and spread the towel, the patient takes the supine position, the affected limb is slightly elevated.

3.4 Puncture and insertion of optical fiber

Under the ultrasound guidance, the diseased vein (e.g., the trunk of the saphenous vein) is punctured in the calf, and a vascular sheath is placed to establish access. Note that vascular access to the saphenous vein is obtained by puncturing between the knee and mid-calf, avoiding ankle level puncture as much as possible.

The ring optical fiber was placed into the trunk of the saphenous vein through the vascular sheath, and the red indicator light at the front end of the auxiliary optical fiber was observed to be delivered into the proximal end of the saphenous vein, and the head end of the ultrasonically positioned optical fiber was 2 cm from the saphenofemoral junction.

3.5 Injection of swelling anesthesia solution

Under ultrasound guidance, a swelling anesthetic solution was injected around the trunk of the vein to be ablated, and the target vein was compressed as close as possible to the fiber optic, while ensuring that the distance between the target vein and the skin was more than 1 cm after injection.

3.6 Treatment of the great saphenous vein and the small saphenous vein

The parameters of the host are set according to the clinical situation (see 3.7), the operator wears laser goggles, depresses the foot pedal to activate the laser, and at the same time withdraws the optical fiber to ablate the vein. During the ablation process, it is recommended that the operator apply a certain amount of pressure along the ablated vein through the skin to ensure that the vein is as close to the fiber as possible.

Ablation of the saphenous vein begins 2 cm distal to the saphenofemoral junction, but does not extend below the knee region. Small saphenous vein ablation is performed by puncture in the lower calf, starting 2 cm distal to the sapheno-popliteal junction.

3.7 Parameterization of continuous retraction of optical fibers

The saphenous vein is set at 6-8 W energy with a linear endovascular energy density (LEED) of 40-50 J/cm².

The small saphenous vein is set at 4-5 W of energy with a linear endovascular energy density (LEED) of 35-40 J/cm².

3.8 Elastic bandage wrapping

Gauze/cotton pads are placed along the course of the ablated vein for eccentric compression, and an elastic bandage is applied for compression.