[A device for endoluminal thermal obliteration of varicose veins]. / Ustroistvo dlia provedeniia éndoliuminal'noi termicheskoi obliteratsii varikoznykh ven.

Amongst the techniques of endoluminal thermal obliteration of varicose veins, the most commonly employed treatment modalities are endovasal radiofrequency ablation and endovasal laser obliteration, both using a generating source and a special device for carrying out thermal obliteration. It has been noted that each of the methods of thermal obliteration has a number of disadvantages, irrespective of using the energy of magnetic oscillations in a radiofrequency range or laser radiation, including high cost of expendable materials and equipment. The device we worked out for endoluminal thermal obliteration of varicose veins was based on the principle of high efficacy and safety, with a significant decrease in the cost of carrying out the manipulation. This was achieved by means of developing a new device wherein a thermal effect is exerted not via the direct impact of laser radiation on the venous wall but at the expense of using laser energy exceptionally for heating a metal tip located at the distal end of high-strength metallized fibre coated with a heat-resistant polymer. Analysing the initial short-term results of using the new technique of thermal obliteration in treating a total of 50 patients presenting with varicose veins made it possible to draw a conclusion on high efficacy of the method and its safety. The proposed device may repeatedly be used with any and simplest-in-design source of laser radiation regardless of the wavelength and power of radiation. Implementation of this technique into clinical practice will make it possible to decrease manifold the cost of the procedure of thermal obliteration of varicose veins, currently carried out with the use of the classic techniques - endovasal laser obliteration and endovasal radiofrequency ablation.

[A new-type device for endovasal laser obliteration of varicose veins]. / Novyi tip ustroistva dlia provedeniia éndovazal'noi lazernoi obliteratsii varikoznykh ven.

The purpose of the study was to work out a Russian-made, simple-to-manufacture, safe, inexpensive and efficient device for performing endovasal laser obliteration (EVLO) of varicose veins, with the underlying principle of endoluminal distribution of the total laser energy into several flows. The development of this device was based on the principle of dividing the total laser radiation into two energy flows. One flow has a shape of circularly formed, continuous field of laser radiation of specified width within the angular range from 50 to 90°, which ensures the main energetic contribution to thermal impact on the vascular wall. The second energetic flow is formed in the part of the tip having a shape of a truncated cone, along the axis of the optical fibre within the angular range from 10 to 50°, which ensures additional thermal effect of radiation on the narrowing walls of the venous channel. Starting from 2016, EVLO with the use of the developed device was performed in a total of 50 patients with class C2-C3 varicose veins. The morphogenesis of the occurring restructuring of the venous wall was studied intraoperatively and in various time periods. Tissue specimens obtained intraoperatively demonstrated in the majority of cases complete or partial intimal detachment, swelling, disorganization of the middle membrane, adventitial loosening with thrombosis of the elements of the vasa vasorum in the majority of portions. The histological specimens harvested at 10 to 14 days were found to contain in the venous wall clear-cut distinct evidence of actively commensing connective-tissue proliferation. At 1 month of follow up the specimens of the veins treated with EVLO using the developed device showed the beginning of collagenisation of the wall, with finally fibrous restructuring and wall hyalinosis by month 3 after EVLO. The proposed device for EVLO of varicose veins makes it possible to act upon the venous wall simultaneously with two energy flows which excludes negative thermal action of excess energy of laser radiation on the vascular wall while using unidirectional radiation in the form of one or even two, but thin rings and, thus, dramatically decreasing reducing the risk for the development of complications. Implementation of the new device into the phlebological practice in Russia in conditions of complete import substitution has significant economic benefit.