Endovenous laser ablation in current practice: technical notes and the total-EVLA concept

Nowadays, thermoablative techniques represent, in accordance with international guidelines, the most used methods in the treatment of varicose veins (great saphenous vein, small saphenous vein, anterior accessory saphenous vein). In endovenous thermal ablation (EVTA) permanent vein occlusion is caused by energy-induced thermal damage of the endothelium, followed by subsequent fibrosis. The main wavelengths used in the field of venous insufficiency are included in the spectrum between 500 nm and 2000 nm. The advantage of the new generation lasers (>1900 nm diode lasers) is that allow to obtain a complete damage to the vein wall using a lower power watts (PW) and a lower linear energy density (LEED, J/cm) due to the greater absorption coefficient. Over the years, also different types of laser fibers have been developed to perform laser ablation treatment. Among the different types we can include the following: bare fibers, Tulip fibers, NeverTouch “jacket” fibers, Mono-Ring fibers, Double Ring fibers and the new Infinite Fibers. Actually, the major varicose tributaries as well as the saphenous veins can be treated by EVLA. In our experience total-EVLA technique has proven to be safe and effective. It can therefore be a weapon to add in the ablative treatment of varicose veins.