A new-type device for endovasal laser obliteration of varicose veins

Sannikov A.B.¹, Emelyanenko V.M.¹, Solokhin S.A.², Zubov B.V.³, Pashinin A.D.³, Karpenko M.V.⁴, Morozova O.N.⁴

1) Department of Additional Professional Education of Healthcare Specialists, Russian National Research Medical University named after N.I. Pirogov, Moscow–Vladimir,
2) Department of Laser Physics, Technological Academy named after V.A. Degtyarev, Kovrov, Vladimir Region,
3) Laboratory of Medical Laser Equipment and Division of Laser Physics, Institute of General Physics named after A.M. Prokhorov, Russian Academy of Sciences, Moscow,
4) Pathoanatomical Division of the Regional Clinical Hospital, Ivanovo, Russia

The purpose of the study was to work out a Russian-made, simple-to-manufacture, safe, inexpensive and efficient device for performing endovasal laser obliteration (EVLO) of varicose veins, with the underlying principle of endoluminal distribution of the total laser energy into several flows. The development of this device was based on the principle of dividing the total laser radiation into two energy flows. One flow has a shape of circularly formed, continuous field of laser radiation of specified width within the angular range from 50 to 90°, which ensures the main energetic contribution to thermal impact on the vascular wall. The second energetic flow is formed in the part of the tip having a shape of a truncated cone, along the axis of the optical fibre within the angular range from 10 to 50°, which ensures additional thermal effect of radiation on the narrowing walls of the venous channel.

Starting from 2016, EVLO with the use of the developed device was performed in a total of 50 patients with class C2-C3 varicose veins. The morphogenesis of the occurring restructuring of the venous wall was studied intraoperatively and in various time periods.

Tissue specimens obtained intraoperatively demonstrated in the majority of cases complete or partial intimal detachment, swelling, disorganization of the middle membrane, adventitial loosening with thrombosis of the elements of the vasa vasorum in the majority of portions. The histological specimens harvested at 10 to 14 days were found to contain in the venous wall clear-cut distinct evidence of actively commensing connective-tissue proliferation. At 1 month of follow up the specimens of the veins treated with EVLO using the developed device showed the beginning of collagenisation of the wall, with finally fibrous restructuring and wall hyalinosis by month 3 after EVLO.

The proposed device for EVLO of varicose veins makes it possible to act upon the venous wall simultaneously with two energy flows which excludes negative thermal action of excess energy of laser radiation on the vascular wall while using unidirectional radiation in the form of one or even two, but thin rings and, thus, dramatically decreasing reducing the risk for the development of complications. Implementation of the new device into the phlebological practice in Russia in conditions of complete import substitution has significant economic benefit.

KEY WORDS: varicose vein, endovasal laser obliteration, device, light guides.

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