Ablation From Wikipedia the free encyclopedia Ablation is
Ablation From Wikipedia, the free encyclopedia Ablation is removal of material from the surface of an object by vaporization, chipping, or other erosive processes. Examples of ablative materials are described below and include spacecraft material for ascent and atmospheric reentry, ice and snow in glaciology, biological tissues in medicine, and passive fire protection materials
Endovenous Laser Ablation (EVLA) Navarro L, Min RJ, Bone C. Endovenous laser: a new minimally invasive method of treatment for varicose veins--preliminary observations using an 810 nm diode laser. Dermatol Surg 2001; 27(2): 117 -22 33 ΑΣΘΕΝΕΙΣ - 40 ΣΑΦΗΝΕΙΣ ΦΛΕΒΕΣ
Ιστορία LASER – Light Amplification by Stimulated Emission of Radiation – Ενίσχυση φωτός με εξαναγκασμένη εκπομπή ακτινοβολίας Stimulated emission: a quantum mechanical effect discovered by Einstein in 1917
ΥΠΟΔΟΜΗ LASERS in EVLA – solid state - diode lasers (810 - 940 - 980 - 1470 -nm) - Nd: YAG (1064 - 1320 -nm)
ΤΡΟΠΟΣ ΔΡΑΣΗΣ Linear Endovenous Energy Density (LEED) – ΔΟΣΗ ΕΝΕΡΓΕΙΑΣ ΤΟΥ LASER ΠΟΥ ΜΕΤΑΦΕΡΕΤΑΙ ΣΤΗ ΦΛΕΒΑ Joules/cm vein 50 < OPTIMUM LEED < 100 J/cm Fluence - laser energy delivered for a given surface area (Joules/cm 2)
Tumescent anesthesia spasm heat sink
Endovenous Laser Ablation (EVLA)
ΠΡΟΩΘΗΣΗ ΤΗΣ ΙΝΑΣ Endovenous Laser Ablation (EVLA)
Tumescent anesthesia Endovenous Laser Ablation (EVLA)
Endovenous Laser Ablation (EVLA)
RF PROCEDURE
Tumescent anesthesia spasm heat sink
RF ablation ΜΟΡΦΟΛΟΓΙΑ ΣΑΦΗΝΟΜΗΡΙΑΙΑΣ ΣΥΜΒΟΛΗΣ ΜΕΤΑ ΤΗΝ ΕΠΕΜΒΑΣΗ J-1: complete SFJ obliteration with no SFJ flow J-2 a: Patent SFJ tributaries draining toward the femoral vein without a short patent saphenous stump J-2 b: same as J-2 a but with the presence of a short patent saphenous stump J-3: terminal GSV competence with normal antegrade flow from both tributaries and the saphenous vein above a limited GSV obliteration
RF ablation procedure ΑΝΑΤΟΜΙΚΗ ΑΠΟΤΥΧΙΑ – Merchant and Pichot Type I – the vein fails to occlude (suboptimal technique) Type II – 23% recanalization rate associated with tributary and/or perforator incompetence Type III – groin reflux, usually involving an accessory saphenous vein (disease progression)
RF ablation procedure ΕΠΙΠΛΟΚΕΣ Closure International Registry 1006 patients DVT – 0. 9% phlebitis – 2. 9% Skin burn – 1. 2% - tumescent was not used in the majority of patients
EVLA Results Author n Wavelength (nm) Occlusion Rate DVT Recurrence Agus et al 1050 810 and 980 99% - 3% Min et al 499 810 98, 2% - 6, 6% Ravi et al 1091 940 97% - 0 Spreafico et al 1020 980 93, 1% (one 0, 6% - - - Pannier et 50 al year) 1470 Radial 100%
EVLA Results RCT: 810 vs 980 – no difference in efficacy – less bruising for the 980 RCT: 980 vs 1470 Radial – better VCSS improvement for the 1470 VCSS: VENOUS CLINICAL SEVERITY SCORE ΑΠΟ ΤΟ AMERICAN VENOUS FOROUM
RF Results Η ΒΙΒΛΙΟΓΡΑΦΙΑ ΕΧΕΙ ΚΥΡΙΩΣ ΑΠΟΤΕΛΕΣΜΑΤΑ ΑΠΟ ΣΥΣΚΕΥΕΣ ΠΡΩΤΗΣ ΓΕΝΙΑΣ Early technical success rates: 89% closure rate @ 3 months 80% closure rate @ 5 years (meta – Van den Bos et al. JVS 2009; 49: 230 -239)
EVLA vs Surgery Study nm F-up Outcome Recurrence Rasmussen et al 980 2 years EVLA =surgery NR Christenson et al 980 2 years EVLA =surgery EVLA>surgery 3 months Early return for EVLA NR Darwood et al Stepwise vs continuous De Medeiros et al 810 16 days Ecchymoses: EVLA>surgery NR Pronk et al 980 1 year Pain: EVLA > surgery EVLA 9% vs Surgery 10%
EVLA vs RF Ablation Ravi et al: 1250 limbs – equal efficacy, no revascularization @ 3 years Almeida et al: Closure. Fast vs 980 (Recovery Trial) – pain, ecchymosis, VCSS, QOL better for RF Gale et al: Lower failures for EVLA @ 1 week and 1 year Rasmussen et al: EVLA vs RF vs Foam sclerotherapy vs Surgery 1470 -nm 500 randomized patients Failures 20% for Foam sclerotherapy group Shorter return to daily activities for foam sclerotherapy and RF groups
ΣΥΜΠΕΡΑΣΜΑΤΑ LASER – RF: ΑΣΦΑΛΗΣ ΚΑΙ ΑΠΟΤΕΛΕΣΜΑΤΙΚΗ ΜΕΘΟΔΟΣ EVLA vs. RF : Current trials NOT conclusive for SUPERIORITY
- Slides: 39