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Endovenous Laser Ablation


This monograph summarises a fifteen-year experience using endovenous laser ablation (EVLA) and is based on data from more than 10,000 patients with varicose veins who were treated with EVLA in the clinics of the National Pirogov Medical and Surgical Centre and Vein Centres “Antireflux” (Russia).

This monograph outlines the fundamentals of EVLA from several different perspectives. The developmental history of EVLA from the viewpoint of the innovation life cycle is reviewed, and concepts that underlie the aetiology and pathogenesis of varicose transformation are presented. Experimental, ultrasound, and morphological data that reflect EVLA’s mechanism of action are obtained using mathematical modelling of the processes occurring in the vein. A detailed description is provided of the anatomical variants of varicose transformation, and the justification behind the use of certain strategies and techniques for using EVLA on various pools of the venous system of the lower extremities is explained. Finally, a detailed analysis of the risks and complications associated with EVLA is provided based on long-term results obtained from a vast body of clinical trials. For practitioners, the appendix offers references to regulatory documents describing the operating rules for EVLA equipment, instructions for use of the laser devices, information about the medical documents required when working with laser devices as well as instructions for the administration of first aid in case of laser-related injury.

This monograph is not only intended for phlebologists and vascular surgeons, but also for general surgeons, physicians specializing in ultrasound and X-ray endovascular diagnostics, and medical students.

Table of contents 3
Foreword to the English Edition (Nick Morrison) 5
Foreword to the English Edition (Mustafa Sirlak) 7
Preface to the Russian Edition (Alexander I. Kiriyenko) 8
Chapter 1. Fundamentals of EVLA 10
1. Light, colour and chromophores 10
2. Laser radiation units used in the clinic 14
3. Three phases of the EVLA mechanism 15
4. The main objective of endovenous  thermal ablation is to irreversibly destroy the collagen in the venous wall 23
5. Optical properties of venous complex tissues 31
6. Mathematical modelling of EVLA 34
7. Causes and conditions for the formation of venous wall perforations during EVLA 39
Chapter 2. Development of the EVLA method within the context of the innovation life cycle 49
Chapter 3. Aetiology and pathogenesis of varicose transformation of lower extremity veins 59
Chapter 4. Treatment of the varicose vein with EVLA 72
1. Indications and contraindications for EVLA 72
2. EVLA technique 75
3. EVLA strategies for different variants of reflux spreading 93
Chapter 5. Mistakes, dangers and complications during EVLA 121
Chapter 6. Long-term EVLA results 160
Conclusion 177

Dear Readers,

As Immediate Past-President of the International Union of Phlebology (UIP) I take this opportunity to introduce this monograph, Endovenous laser ablation. А fifteen-year experience and more than 10,000 procedures, on behalf of the National Pirogov Medical and Surgical Centre and Vein Centres Antireflux, a very important partner within the UIP community.

The leadership of the National Pirogov Medical and Surgical Centre and Vein Centres Antireflux have produced a truly outstanding manuscript regarding endovenous laser ablation, one which should become an indispensable tool for all those practicing in the field of venous medicine, both in Russia and indeed around the world. This work is not only welcomed but deeply appreciated by the international venous community.

For any practitioner just beginning an interest in the modern treatment of venous disease, this monograph should be indispensable. But also, for the surgeon experienced in all modalities of venous disease therapy who possesses the scientific curiosity about the origins of laser ablation, the physics involved, and the practical cellular effects of a laser ablation, here is thorough treatise well worth the effort to read and understand it. Beginning with the effects of laser on human tissue, carried through both a factual and theoretical discussion of surgical modalities and the therapeutic decision process, the benefits and risks of laser venous therapy — all presented in a brilliant and understandable style. As a bonus, there is a discussion of the evolution of a newly introduced treatment modality that is unlike anything I have read.

I was initially asked to write the foreword for this work, and expected to read through the table of contents, lightly browse through the text, and produce a foreword. Instead, I was so engrossed in the information presented that I carefully read through the entire manuscript. Consequently, it is a great honor to recognize the work involved in the production of this text and my congratulations to the authors for their tremendous efforts to elevate knowledge in the field of venous medicine.

With great respect,
Nick Morrison,

Immediate Past-President, 
International Union of Phlebology