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Endovenous Laser Ablation

The newest technology available for the treatment of venous insufficiency or varicose veins is endovenous laser ablation. Endovenous laser ablation is minimally-invasive and performed under local anesthesia in the Vein Center (thus avoiding hospital and anesthesiology charges.) The procedure takes about an hour. Most of our patients report negligible intraoperative and postoperative pain, and do not even require the prescribed hydrocodone. Patients are up walking in 5-10 minutes and back to work or normal activities in 2-3 days.

Endovenous laser ablation is performed under ultrasound guidance. Patients are sedated (but remain awake) and given lidocaine tumescent anesthesia. A thin laser fiber is threaded into the diseased saphenous vein through a tiny (2mm) needle incision. The fiber is directed to the uppermost portion of the vein, the laser is activated, and the fiber is withdrawn. The laser gently heats the lining of the vein and safely seals it shut. The moment the diseased vein is sealed, the blood that had been refluxing within it is redirected to the healthy deep veins and thus returned to the heart. After the laser ablation, the treated vein slowly dissolves and is absorbed by your body. The varicose veins that were created by the diseased saphenous vein are then easily and permanently treated.

ACE wraps are applied when the treatment is complete. They are worn for the next 2-3 days to assist in resolution of the treated saphenous and varicose veins. A postoperative ultrasound is performed on day 2 or 3 to confirm successful ablation of the treated veins. The ACE wraps are replaced by compression stockings, which are worn daily for the next two weeks.

CoolTouch 1320 nm Endovenous Laser

The laser’s wavelength is one of the most critical components in the overall success of endovenous laser treatment. The CoolTouch CTEV™ 1320 nm laser was developed for endovenous ablation in an attempt to circumvent side effects associated with shorter hemoglobin-absorbing wavelengths. US FDA clearance was awarded in September 2004 for treatment of the Great Saphenous Vein, and in August of 2005 for treatment of the Small Saphenous Vein. Since that time, the CTEV has been used to successfully treat thousands of patients with varicose veins.

CoolTouch CTEV’s proprietary 1320 nm wavelength gives it a tremendous advantage over other endovenous lasers on the market. It has proven to be extremely effective and comfortable in the treatment of varicose veins. The unique feature of the 1320 nm wavelength is that it targets collagen in the vein wall and does not interact with hemoglobin in red blood cells. It therefore requires less heat to permanently close the vein than do competing, shorter wavelengths. This gentle, controlled heating contracts the vein, leading to closure and successful ablation of the vein.

Competing endovenous lasers are different than the CoolTouch CTEV. They use a diode, which generates shorter wavelengths (810, 940, or 980 nm) that target hemoglobin in red blood cells for laser energy absorption. This can result in extremely high temperatures. The high heat generated by the older, shorter wavelength diode lasers can actually rupture the vein - causing significant pain, swelling, and bruising.

According to endovenous expert, Dr. Robert Weiss (associate clinical professor of dermatology at Johns Hopkins University School of Medicine) “the CoolTouch CTEV 1320 nm wavelength is the ideal wavelength for this procedure. It is very safe and extremely effective, with a long-term success rate of 98%. It will be the standard to be beaten by any other technique. Physicians and patients alike will be greatly impressed when they see the difference in results between the new CoolTouch 1320 nm laser and the competing 810, 940, and 980 nm laser systems. It is truly the best technology available today.”

In a recent study by Dr. Thomas Proebstle (Professor of Dermatology and Phlebology, University of Heidelberg, Germany), fewer patients complained of postoperative pain, patients used less postoperative pain medications, and less postoperative ecchymosis (bruising) and redness was noted in those who underwent treatment with the CoolTouch 1320 laser than in those who underwent treatment with a shorter wavelength diode laser.1 Dr. Proebstle felt the lower side-effect profile of the CoolTouch 1320 laser was due to the absorption properties, which cause an inability of the laser to produce vein wall perforations during Endovenous Laser Therapy. 100% of the patients treated with the CoolTouch 1320 nm CTEV were successfully occluded.

Mitchel P. Goldman, M.D. (Associate Clinical Professor of Dermatology University of California, San Diego, School of Medicine) demonstrated that treatment with the CoolTouch 1320 nm laser resulted in 100% occlusion of the great saphenous vein without evidence of recurrence at 6 to 12 month follow-up. "In fact”, reports Dr. Goldman, “The treated vein was not identifiable by duplex examination six months after treatment, and there was no recurrence of any varicose veins at any time during our follow-up.” He found treatment with the CoolTouch laser was not complicated by postoperative pain or bruising that occurs when the shorter wavelength diode lasers are used for intravascular treatment of the great saphenous vein. He felt this was due to the lack of interaction of the 1320 wavelength with hemoglobin in red blood cells and the extreme heat this creates.2 According to Dr. Goldman, “Having helped develop the radiofrequency Closure® procedure and treating dozens of patients with the 810 nm EVLT™, I have found that the Cool Touch CTEV™ 1320 nm procedure produces the best results in the quickest, most affordable and patient-friendly manner.”

  1. Proebstle, Thomas M., Moehler, Thomas, Gül, Doendue & Herdemann, Sylvia (2005) Endovenous Treatment of the Great Saphenous Vein Using a 1,320 nm Nd:YAG Laser Causes Fewer Side Effects than Using a 940 nm Diode Laser. Dermatologic Surgery 31 (12), 1678-1684.
  2. Goldman, Mitchel P., Mauricio, Maritess & Rao, Jaggi (2004) Intravascular 1320-nm Laser Closure of the Great Saphenous Vein:
    A 6- to 12-Month Follow-up Study. Dermatologic Surgery 30 (11), 1380-1385.

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