Intravascular lasers in the treatment of varicose veins

Historically, surgical treatments, such as high ligation or complete removal of an incompetent greater saphenous vein, were used to treat varicose veins resulting from saphenofemoral junction reflux. The relative lack of efficacy of these invasive methods, along with potential morbidity and significant patient downtime, has inspired the search for other treatments. Endovenous radiofrequency closure of the greater saphenous vein is effective and safe but its high cost, in terms of non-reusable catheters, and its slow withdrawal rate impair its practicality. A new technique for endovenous occlusion using endoluminal laser technology offers a less invasive alternative to ligation and stripping as well as a faster and less expensive method to treat varicose saphenous trunks and junctions. Initial clinical experience in several hundred patients shows a high degree of success with minimal side effects, most of which can be prevented or minimized by minor modifications of the technique. This paper reviews the use of an intravascular laser to destroy varicose veins. Various wavelengths including 810, 940, 980, 1064 and 1320 nm have been used to produce intravascular destruction of varicose veins. The 1320-nm intravascular laser with a motorized pull-back system appears to be the most efficient and reproducible system to effectively close and/or destroy an incompetent greater saphenous vein.