الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 98 |  |  |
| | | from | 98 | | |
Abstract
The natural history of varicose vein has received increased attention as our understanding and imaging capabilities of venous system have developed over the past three decades. Lower extremity varicose vein is a common medical condition that affects approximately 25% of women and 15% of men.
In the recent years, new trends of treatment for varicose veins have started to become popular .The main aims of all new interventionsare to reduce trauma to the patient, fasten full recovery, avoid general anesthesia, avoid groin incisions and decrease incidence of thigh hematomas.Due to higher patient’s satisfaction, shorter recovery times, lower cost and ease of operation, EVLT of the great and/or short saphenous vein has become the treatment of choice of varicose veins.
Endovenous Laser therapy of the GSVwas first described by Puglisi in1989 in the International Union of Phlebologyand the first successful results were reported by Navarro in 2001.Although no multicenter clinical trials of the safety and efficacy of this procedure in humans have been published, many case series and some analysis of pathophysiological effects have been published subsequently.
EVLT of GSV was approved by FDA in 2002 and SSV was approved in 2003.Lots of manufacturers produce Laser generators, all of which seems to be effective in the thermal ablation of the incompetent varicose veins. Semiconductor (diode) Lasers have been the main Laser type employed for this treatment.
Clinical trial experience with diode Lasers has produced extremely low rates of deep vein thrombosis (DVT),paraesthesia, a low risk of skin burns and no documented cases of pulmonary embolism.
Since EVLT only treats junctional and truncal vein incompetence, a variety of adjunctive procedures have been described with EVLT, these include radiofrequency ablation, foam sclerotherapy and local anesthetic phlebectomies at a later date if reflux persists.
The issue of whether to perform concomitant phlebectomies or sclerotherapy (foam or liquid) in conjunction with EVLT has attracted considerable debate, the alternative is delayed sclerotherapyor local anestheticphlebectomies seems to be a more sensible approach.Protagonists of the former suggest that patients prefer to complete their treatment in a single visit.
Conversely, it has been shown that when EVLT is commenced at or below the lowest point of truncal vein reflux only 17% of patients with GSV reflux and 11% with SSV incompetence have residual varicosities requiring treatment after EVLT alone. Thus, with concomitant therapy many patients undergo unnecessary treatment that may require additional resources and increase the cost of the procedure.
As a simple rule it can be said that “if you cannulate, you can treat any vein” with indication of treatment. Due to its anatomic localization treatment of incompetent SSV with EVLT is superior to surgical stripping. It has been shown that ligation of the SPJ is not achieved in 30% of the cases even if the junction is marked pre-operatively under ultrasound guidance. In the EVLT, there is not a problem like that;ifthere is anatomic SPJ you can treat the incompetent SSV without having any surgical difficulties.
EVLT shows minimal side effects in comparison with other surgical methods, patients can walk immediately after surgery and recovery times are short. The EVLT procedure can be performed in an outpatient setting and usually only local anesthesia is required.