(RESULTS OF PROSPECTIVE NONCOMPARATIVE STUDY) The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia The clinic of phlebology and laser surgery “Vasculab” Ltd., Chelyabinsk, Russia Professor Fokin A.A., Borsuk D.A. ENDOVENOUS LASER ABLATION OF THE SAPHENOUS VEINS MORE THAN 2 CM OF THE DIAMETER (RESULTS OF PROSPECTIVE NONCOMPARATIVE STUDY) 30th ACP Annual Congress November 3-6, 2016 Anaheim, CA, USA 1 1

Clinical Practice Guidelines – Management of CVD The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia 2

Clinical Practice Guidelines – Management of CVD The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia 3

Clinical Practice Guidelines – Management of CVD The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia 4

The literature is considered a large diameter greater than 1 cm Chaar C.I., Hirsch S.A., Cwenar M.T., et al. Expanding the role of endovenous laser therapy: results in large diameter saphenous, small saphenous, and anterior accessory veins. Ann Vasc Surg. 2011 Jul; 25 (5): 656-61.   Florescu C., Curry G., Buckenham T. Role of endovenous laser therapy in large and very large diameter great saphenous veins. ANZ J Surg. 2016 Jul; 86(7-8): 608-11. The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia

Laser Wavelength Hemoglobin- and Water-specific H-lasers 810 nm 970 nm W-lasers 1380 nm 1470 nm 1560 nm The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia

Bare Fiber The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia 7

Radial Fiber The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia 8

2-ring Radial Fiber The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia 9

Aim The aim of this study was to investigate the results of endovenous laser ablations (EVLA) of the saphenous veins more than 2 cm of the diameter Technical result: occlusion of the treated vein Hemodynamic result: presence or absence of reflux 1 2

Material and Methods GSV SSV AASV EVLA Prospective noncomparative study Includes 87 patients Operated from November 2014 until May 2016 91 EVLA Wavelength 1470 nm Power 6-10 W LEED 83,3-164 J/cm The diameter of the veins close to sapheno- femoral junction was from 21 to 43 mm (mean 28±4,5 mm) The observation period was from 71 to 450 days (mean 157±47 days) EVLA GSV SSV AASV The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia 11

Results 91 EVLA Early follow-up period Occlusion in 87 (95,6%) cases 2nd postoperative day 7th postoperative day 91 EVLA Occlusion of the vein in 84 (92,3%) cases In 7 (7,7%) cases the rest lumen was found Occlusion in 87 (95,6%) cases In 4 (4,4%) cases the rest lumen was found In 4 (4,4%) cases we performed ultrasound-guided foam-form sclerotherapy The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia

Results Middle-term follow-up Over the period of 3-6 months the small stumps of GSV (mean 21 mm ± 5 mm) were found of 3 (3,3%) patients. In all cases it wasn’t reflux in this stumps. Also only in 1 (1,1%) case we found recanalization with pathological reflux. This patient was treated by UGST. There was no necessary to retreat patients by EVLA. The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia

The position of the fiber in the vein after tumescence Formation of "blind pocket" The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia

Clinical case Position of the fiber in the middle The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia 15

Clinical case The "Blind pocket" The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia 16

Clinical case Residual lumen the next day after the intervention The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia 17

Clinical case After 1 week there is no blood flow The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia 18

Clinical case The vein is more than 42 mm of the diameter The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia 19

Clinical case 26 days after EVLA the vein is 30 mm of the diameter The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia 20

In 1 (1,1%) case UGST has been done. Conclusions 1 2 EVLA 1470 nm by radial fibers are really effective also for the veins of the diameter more than 2 cm. We have found occlusion of GSV of 98,9% cases in the middle-term follow-up period. In 1 (1,1%) case UGST has been done. This direction is demanded more significant investigation with comparing with open surgery and evaluation of QOL and severity of pain syndrome The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia

Thank you for attention ? ? ? Any questions? The education department of surgery of the South Urals Medical University, Chelyabinsk, Russia