Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: Thrombotic occlusion after endoluminal thermal damage by laser-generated.

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Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: Thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles T.M. Proebstle, MD, MSca, H.A. Lehr, MD, PhDb, A. Kargl, MDa, C. Espinola-Klein, MDc, W. Rother, PhDd, S. Bethge, MDa, J. Knop, MD, PhDa Journal of Vascular Surgery Volume 35, Issue 4, Pages 729-736 (April 2002) DOI: 10.1067/mva.2002.121132 Copyright © 2002 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 Macroscopic and microscopic hematoxylin and eosin-stained histopathologic examination of a GSV that has undergone EVLT before stripping. A, Outer surface of the endovenously laser-treated GSV. Dark spots resembling carbonization, or even full perforation of the vein wall, were caused by direct impact of the 940-nm laser beam. B, Intimal tear next to a non-perforating laser hit. C, Vein wall disruption caused by direct laser impact. D, High magnification of the margin area of vein wall disruption showing pronounced thermal damage, including carbonization. Journal of Vascular Surgery 2002 35, 729-736DOI: (10.1067/mva.2002.121132) Copyright © 2002 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 A, Schematic drawing of the in-vitro set-up for examining the laser-generated steam bubble formation. The laser fiber was inserted into a silicone tube of 6-mm-diameter filled with heparinized blood. During delivery of laser energy, heating and boiling of the blood finally lead to the formation of a steam bubble, pushing the corresponding blood volume out of the tube. Thus, the movement of the blood level in the smaller 2-mm-diameter tube allowed the calculation of the volume of the steam bubble in reverse. B, Visible steam bubble formation during delivery of a laser pulse of 15 J. C, Dependency of the steam bubble volume for various amounts of energy delivered by the laser beam. Journal of Vascular Surgery 2002 35, 729-736DOI: (10.1067/mva.2002.121132) Copyright © 2002 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 Indirect, steam bubble-mediated thermal damage after EVLT, several millimeters away from areas of direct laser impact. A, Control: normal varicose vein after stripping without earlier EVLT, with intact endothelium and distinct cellular contours. The nuclei are round to oval. B, EVLT resulted in a lift-off of endothelial cells, a denudation of the intima, loss of cellular contours, and fibrin deposition. Additionally, some areas show marked vacuolization of cells or even spongiosis. C, Swelling and waxy homogenization of collagen. Focal coagulation necrosis within the intima. Journal of Vascular Surgery 2002 35, 729-736DOI: (10.1067/mva.2002.121132) Copyright © 2002 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions