Comparative analysis of the results from the endovenous laser ablation with wavelength of 980 and 1470 nm biolitec AG Dr. A. Angelov*, Dr. D.Golemanov** Dr. А. Anastasov***, Dr. D. Petkov**** Dr. Hr. Georgiev***** , Doz.Dr.V.Petrov, DM *Hospital SHBAL “Prof.Т.Temelkov – Varna; Medical Center ”Varna-Bregalnitsa”-EOOD - Varna **Medical Center “Oksicom” OOD – Burgas ***Medical Center ”Panaceya” – Sofia ****Hospital MBAL “Sv. Ivan Rilski” – Stara Zagora *****Hospital MBAL “G. Oryahovitsa” Marc Richly, Medical Sales Manager - Biolitec AG

Linear and radial fiber lasers

Absorption in water medium and by the hemoglobin molecule at wavelength of 980 nm

Absorption in water medium and by the hemoglobin molecule at length of the wave of 1470 nm

ELVeS™ – Endo Laser Vein System EVLT – the method has a unique application in all the forms of chronic venous insufficiency: Vena saphena magna Vena saphena parva Relapsed varices Reticular varices Lateral branches Ulcera cruris venosum … 1470 nm Wellenlänge gegenüber 980

EVLT – varicose treatment of VSM and VSP Surgivals desinfection of the skin; Puncture of the vein in the point of the distal insufficiency; Introduction of a drive, a catheter and a laser fiber; After the correct positioning of the fiber follows the injection of a tumescent anesthesia - under permanent ultrasonic guidance; Slow withdrawal of the catheter; Pulling on of a medical socking of second compression class.

Patient G.D.

Material and methods Reporting period: from 22 Jan. 2007 to 22 Jan. 2012 – for the group of 980 nm and from 13.05.2009 to 13.02.2012 – for the group of 1470 nm; Number of patients – 1100, from which 691 of the group of 980 nm and 409 – for the group of 1470 nm; Number of extremities – 1199, as for 99 patients the procedure was applied on both extremities; Age – between 18 and 82 years of age; average 43,7 years; Proportion men:women - 45:55 %; Interrelation of varicosity of the left and of the right leg – light majority for the left side.

Our patients – division by age

Division by sex and affected side 760 Women 340 Men

Division by the complexity of the Chronic Venous Insufficiency /CVI/

Working parameters The transformation of the laser energy into thermic energy obeys the law of Lambert-Bier. The quantity of the energy radiated into the tissue with fibers of 980 nm is calculated after the following formula: The interior diameter of the vein х 10 = the Energy (in Joules) Example: 10 mm х 10 = 100 J E(joules) = the capacity of the device(in watts) х the time(sec) Example: 100 J = 15 [W] x 6,7 [s] The quantity of the energy radiated into the tissue with fibers of 1470 nm is calculated after the following formula: Example: 10 mm х 5 = 50 J E(joules) = the capacity of the device (in watts) х the time (sec) Example: 50 J = 7 [W] x 7,1 [s]

Criteria for comparative analysis Duration of the procedure Quantity of the tumescent anesthesia injected Presence of post treatment hematoma and ecchymosis Post treatment parasthesia Necessity of taking nonsteroidal anti-inflammatory drugs after the treatment procedure Evaluation of the strength of the pain according to a 10 point scale Stem relapses

Patient in the 6th stage of CVI

Laser ablation with 1470 nm of a patient in the second stage of CVI

Laser ablation with 980 nm, combined with a mini flebectomia by Varady

Laser ablation with 980 nm, combined with a mini flebectomia by Varady

The patient V.А., aged 35 - treatment of both legs

Laser ablation with 1470 nm, combined with a mini flebectomia by Varady

Laser ablation with 980 nm, combined with a mini flebectomia by Varady

Our first patient – 22.01.2007 – in the 6th stage of CVI; treatment with 980 nm

Our tasks at endolumen laser ablation: Tortuous and non-functioning vena saphena, the organism is gradually transforming into a connective tissue; Proven reflux at the entry of the saphena magna up to 20 mm and a good drainage of the blood via vena epigastrica inferior; Perfect passibility of the deep vein.

І. Our conclusions: priorities of the endovenous laser therapy towards the stripping: The stay of the patients in the clinic is only 2 hours, which includes the time for the laser ablation; No need of general anesthesia; No mutilating cuts; and most important - there is no inguinal cut; The lymph paths are not traumatized; No radial stress; No blood loss; Minimal risk of infection.

ІІ. Our conclusions: priorities of the endovenous laser therapy towards the stripping The treatment is completely applicable to patients with anticoagulation therapy, without interrupting it; The treatment is completely applicable to patients with a pacemaker; The work capacity of the patients is completely preserved the day following the laser ablation; The endovenous laser treatment under permanent sound control is a completely reliable method and is a real alternative to the operative method – stripping, introduced by Babcock in 1907; Great satisfaction of all the patients cured by means of the ELVeS-method – both in terms of healing and in terms of aesthetic results.

Our conclusions: priorities of the 1470 nm wave towards the 980 nm wave During the work with the radial laser fibers and length of the wave of 1470 nm do not establish trunk relapse with patients observed; in the group treated with 980 nm - 11 patients (0,9%); The radial emission provides for a perfect contact with the whole wall, thus this reduces the output and the quantity of the energy emitted; The wave of 1470 nm does not provoke carbonization, therefore there is no absorption of the hemoglobin by the molecule; In the group of 1470 nm the quantity of tumescent anesthesia is two times less; The procedure with the radial emission of energy is about 30 % faster; There are no pains, or if any, they are insignificant; the necessity of post-procedure anesthesia is practically null; Perfect aesthetic results.

Our conclusions: priorities of the wave of 1470 nm in comparison with the wave of 980 nm There are insignificant hematoma or ecchymosis revealed after the procedure; There are single cases of paraesthesias due to affection or stimulation of the Nervous saphenous within the group of 1470 nm; The tips of the radial fibers are better “visualized”during the ultrasonic control; The smoothness of the radial fiber never causes the rupture of the venous wall; The lower operating temperature of the radial fiber does not allow burnings of the skin and the subcutaneous tissue; The wave of 1470 nm can be applied for treatment of spider veins and reticular veins.

Thank you for your attention!