2 Things New! 1290nm Laser & New Saphenous Vein Closure Device

2 Things New! 1920nm Laser & New Saphenous Vein Closure Device

Lowell S. Kabnick, MD

NYU Langone Medical Center

A Novel Secure Percutaneous Vessel Occluder

for Venous Reflux Disease

Vessel Occluder

Deployment Occlusion

Occluder in Action

Transection of Occluded Carotid Artery

Physician

‣ Can reduce procedural time

‣ Allows treatment of multiple areas of incompetence in a single session

‣ No capital expense

‣ USG skill known

‣ Minimal post-intervention care

‣ Can be coupled with other procedures-ex. chemical

‣ CHIVA

Potentials

Patient

‣ Local anesthesia (not tumescent)

‣ Minimal discomfort

‣ No recovery period

‣ No compression therapy needed

Potentials

▶ Small Saphenous Vein Reflux

▶ Refluxing Junctional Tributaries

▶ Perforator Reflux

▶ Reflux in Large Tributaries

▶ Recurrent Reflux after Ablation

Therapies

▶ Veins too tortuous to ablate

▶ Prevention of Chemical Creep

▶ Ligation in conjunction with

chemical therapies, sclerosants,

glues

▶ CHIVA AVMs

Indications

1920nm Diode Laser

(Drawing)

Group 1 1470nm laser

• n = 46 (limbs)

• 32 pts, 24 female, 8

male

• 46 limbs

• 41 GSV

• 5 SSV

medium follow-up: 242.7 days ±146.4•Medium age: 54.3 ± 14.7•LEED medium: 24.6 ± 5.3 J/cm

Group 2 1920nm laser

• n = 55 (limbs)

• 38 pts, 28 female, 10

male

• 55 limbs

• 48 GSV

• 7 SSV

medium follow-up: 163.1 days ±

50.0

• Medium age: 52.2 ± 12.9

• LEED medium: 17.3 ± 4.5 J/cm

1470nm

Power:

• 7 to 10W GSV

•3 to 6 W SSV

1920nm

Power:

• 5 to 6 W GSV

• 3 to 5 W SSV

Operative variables 1470nm 1920nm

Operative time (min) 32.9 ± 12.1 25.0 ± 7.9

Mean total energy (J) 174.30 ±

389.0

823.4 ± 353.3

LEED (J/cm) 24.6 ± 5.3 17.3 ± 4.5

LEED - GSV (J/cm) 24.6 ± 5.4 17.9 ± 4.5

LEED - SSV (J/cm) 24.2 ± 3.9 13.7 ± 2.5

Post-operative variables

Bruising (Ecchymosis) 21 (45.7%) 12 (21.8%)

Induration 18 (39.1%) 7 (12.7%)

Paresthesia 5 (10.9%) 3 (5.5%)

Skin burn 0 0

Deep venous thrombosis 0 0

Days to return to normal

activities

2.7 ± 2.4 4.3 ± 2.5

Days of use of

analgesics

2.0 ± 2.5 2.0 ± 2.3

Days with pain 2.8 ± 2.7 1.7 ± 2.0

pre-op 7 day 1 month 3 months

CEAP

1470nm

1920nm3.4 ± 0.9

3.3 ± 0.6

3.1 ± 1.3

2.3 ± 1.3

2.4 ± 1.5

2.2 ± 1.4

2.3 ± 1.6

2.2 ± 1.4

VCSS

1470nm

1920nm 7.7 ± 2.7

7.7± 2.7

2.2 ± 1.7

2.4 ± 1.4

1.5 ± 1.4

1.5 ± 1.1

1.2 ± 0.9

1.4 ± 1.0

Closure Rates

Group 1

Laser 1470 nm

(n = 46)

Group 2

Laser 1908 nm

(n = 55)

1 week 97.3% ± 12.5 95.9% ± 13.3

1 month 97.1% ± 12.7 91.8% ± 17.3

3 months 95.1% ± 17.3 91.2% ± 19.1

Division of Vascular and Endovascular Surgery