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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: 15 March 2025 | Viewed by 10564

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Special Issue Editors

Prof. Dr. Karin Pfister

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Guest Editor

Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany
Interests: vascular surgery; complex endovascular surgery; critical limb ischemia; vascular imaging; ultrasound; aortic dissection; aortic aneurysm; vascular graft infection

Prof. Dr. Fiona Rohlffs

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Guest Editor

Department of Vascular Surgery, Section Aortic Surgery, University Hospital Regensburg, Regensburg, Germany
Interests: vascular surgery; aortic aneurysm; aortic dissection; complex endovascular aortic procedures; vascular malformation

Special Issue Information

Dear Colleagues,

Recent publications on peripheral arterial disease, including critical limb ischemia and amputation, as well as on aortic pathologies, have influenced the daily decisions made in vascular medicine. The guidelines have been updated to consider the concepts of an ageing population and palliative care. In addition, new technologies including imaging 3D fusion techniques and intraoperative ultrasound broaden the armamentarium, especially in the field of endovascular surgery. New techniques such as in situ fenestration, the further development of available stent grafts (e.g., single branch aortic arch stent graft), as well as endovenous ablation and thrombectomy in acute and chronic conditions are coming to the forefront. So-called orphan diseases such as pelvic venous disorder and vascular malformations demand our attention. There are many new findings and techniques within vascular medicine presently; additionally, strategies that were thought to be outdated are experiencing a renaissance in their assessment, for example, lumbal sympathectomy and neuromodulation. Furthermore, new options have been opened up in the treatment of chronic wounds.

In this Special Issue, we welcome authors to submit papers focused on all of these, and more, abovementioned areas to highlight the current and new trends in vascular and endovascular surgery.

Prof. Dr. Karin Pfister
Prof. Dr. Fiona Rohlffs
Guest Editors

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Keywords

vascular surgery
endovascular surgery
carotid endarterectomy
peripheral vascular diseases
vascular imaging
aortic diseases
aortic aneurysm
arteriovenous malformation
pelvic venous disorder
endovenous procedures
pal-liative therapy concept

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18 pages, 2781 KiB

Open AccessArticle

Comparative Analysis of Surgical and Endovascular Approaches for Isolated Aortic Coarctation Repair across Age Groups: Outcomes and Long-Term Efficacy

by Nur Dikmen, Evren Ozcinar, Zeynep Eyileten, Ali Ihsan Hasde, Levent Yazicioglu, Bulent Kaya and Adnan Uysalel

J. Clin. Med. 2024, 13(19), 5814; https://doi.org/10.3390/jcm13195814 - 28 Sep 2024

Viewed by 729

Abstract

Background: Aortic coarctation, a condition characterized by localized narrowing of the aorta, can be managed with either surgical or endovascular techniques. This study aims to compare these approaches concerning long-term outcomes, particularly re-coarctation rates and late arterial hypertension. Methods: We retrospectively analyzed data from patients with native, isolated aortic coarctation treated by surgical or endovascular methods between 2015 and 2024. Clinical and demographic data were collected from electronic health records. Blood pressure was measured using oscillometric devices, and transthoracic echocardiography (TTE) was performed by an experienced sonographer. The primary endpoint was to identify which treatment predicted re-coarctation during follow-up, while the secondary endpoint assessed the incidence of late arterial hypertension. Results: Sixty-nine patients were included, with a mean age of 18.14 ± 8.18 years (median 16 years; range 8 to 37 years) and a median follow-up of 3 years (range 6 months to 8 years). Of these, 67 (97.1%) underwent elective repairs. Repair techniques included endovascular treatment (24.6%), surgical end-to-end anastomosis (47.8%), and surgical patchplasty (27.5%). The endovascular group was significantly older (29.82 ± 5.9 years vs. 14.33 ± 4.25 years, p = 0.056) and had shorter procedure durations and hospital stays. One-year freedom from reintervention was significantly higher in the surgical group (98.7%) compared to the endovascular group (88.23%) (p < 0.001). Conclusions: Both techniques effectively treat aortic coarctation, but surgical repair offers better long-term outcomes, while endovascular repair provides shorter recovery times. These findings should inform the choice of treatment modality based on patient-specific factors and clinical priorities. Full article

(This article belongs to the Special Issue Current Trends in Vascular and Endovascular Surgery)

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13 pages, 1750 KiB

Open AccessArticle

The Long-Term Results of Covered Endovascular Aortic Bifurcation Repair in Complex Aortoiliac Disease: A Two-Year Follow-Up

by Nur Dikmen, Evren Ozcinar, Fatma Akça, Emre Sen, Ali Fuat Karacuha, Ahmet Kayan and Levent Yazicioglu

J. Clin. Med. 2024, 13(19), 5684; https://doi.org/10.3390/jcm13195684 - 24 Sep 2024

Viewed by 644

Abstract

Background: We aimed to investigate the two-year outcomes of covered endovascular reconstruction (CERAB) of the aortic bifurcation in patients with complex aortoiliac occlusive dis ease. Methods: This study was prospectively initiated, with data retrospectively collected from 40 patients categorized as TASC II B, C, and D based on computed tomography angiography (CTA) findings. All patients underwent the CERAB procedure. We assessed the procedural outcomes, including clinical and symptomatic improvements, as well as patency rates over a two-year follow-up period. Results: A total of 40 patients (33 males and 7 females) with aorto-occlusive disease were treated using the CERAB procedure and included in this observational study. The technical success rate was 100% across all procedures. At 36 months, the overall primary patency, assisted primary patency, and secondary patency rates were 85%, 90%, and 92.5%, respectively. Conclusions: The two-year results of this study suggest that CERAB offers patency rates comparable to those reported in other studies for complex aorto-occlusive bifurcation diseases. The procedure showed favorable patency rates, particularly for more advanced TASC II B, C, and D lesions. Full article

(This article belongs to the Special Issue Current Trends in Vascular and Endovascular Surgery)

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15 pages, 1884 KiB

Open AccessArticle

May Patients with Recurrent Venous Disease Benefit from Sequential Treatment More than Those without Previous Intervention? A Single-Center Retrospective Study on the Safety and Efficacy of Abdominal and Pelvic Veins Embolization in Sequential Approach

by Cezary Szary, Justyna Wilczko-Kucharska, Krzysztof Celejewski, Małgorzata Łodyga, Marcin Napierala, Dominika Plucinska, Siavash Swieczkowski-Feiz, Jerzy Leszczynski, Michal Zawadzki and Tomasz Grzela

J. Clin. Med. 2024, 13(17), 5053; https://doi.org/10.3390/jcm13175053 - 26 Aug 2024

Viewed by 1047

Abstract

Background/Objective: The endovenous embolization of insufficient abdominal/pelvic veins is the preferred method of treatment. Also, it seems to be crucial in the treatment of lower limb vein insufficiency, particularly in recurrent disease. This study aimed to evaluate of pelvic vein embolization safety and its impact on the short-term outcome in the sequential treatment of venous disease. Methods: A retrospective analysis involved data from 506 female patients with venous disease involving abdominal and pelvic veins. All records were extracted from the medical database and included patient history, imaging reports as well as pre- and post-operative surveys. Results: Among the patients analyzed, 37.2% underwent some venous intervention in the past, with significant differences in symptom severity between groups. The embolization procedure revealed a high safety profile, with no serious complications. Pain during and after the procedure was generally low, with significantly lower pain scores in patients with recurrence. In patients who required left renal vein venoplasty a 1.7-fold increased risk of lumbar pain after embolization and venoplasty procedure was observed. Overall, 66.6% of patients reported improvement in pelvic symptoms and 72.1% experienced improvement in leg symptoms. The full sequential treatment protocol (abdominal, pelvic, and leg compartment) demonstrated superior outcomes in leg symptom improvement compared to embolization alone. Conclusions: Pelvic vein embolization is a safe and effective method of treatment, significantly improving both pelvic and leg symptoms, particularly in patients with a history of previous interventions in lower limb veins. Further studies are warranted to validate our findings and further refine treatment protocols. Full article

(This article belongs to the Special Issue Current Trends in Vascular and Endovascular Surgery)

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10 pages, 454 KiB

Open AccessArticle

Beyond the Slopes and Highways: Endovascular Repair of Blunt Traumatic Aortic Injuries after Skiing versus Motor Vehicle Accidents

by David Wippel, Maximilian Lutz, Michaela Kluckner, Leonhard Gruber, Alexander Loizides, Jennifer Fischer, Elke R. Gizewski, Florian K. Enzmann and Sabine Wipper

J. Clin. Med. 2024, 13(11), 3315; https://doi.org/10.3390/jcm13113315 - 4 Jun 2024

Viewed by 730

Abstract

Background: Blunt traumatic aortic injury (BTAI) is a potentially fatal condition, typically resulting from high-velocity trauma. To date, little is known about this type of injury among skiers, who form the largest patient cohort with aortic injuries in the alpine region of Tyrol, Austria. Methods: This retrospective, single-center study at the University Hospital of Innsbruck analyzed patients who underwent endovascular treatment for blunt traumatic aortic injury from 2005 to 2023. Patient data were extracted from electronic and digitalized medical history records. Subsequent analyses compared the baseline characteristics and clinical results of the skiing accident (SA) group to the motor vehicle accident (MVA) group. Results: A total of 48 BTAI patients receiving TEVAR were included, 25 (52%) from SAs versus 23 (48%) from MVAs, who were predominantly male (92% vs. 78.3%). Despite similar preoperative risk profiles and ASA Scores (1.44 vs. 1.74) and no marked differences in BTAI injury grades or the affected aortic zones, significant disparities emerged: the SA group experienced shorter median ICU stays (3 vs. 11 days, p = 0.0007), fewer concomitant injuries (5 vs. 7, p = 0.005), and lower Injury Severity Scores (ISSs) (29 vs. 33, p = 0.003) than their MVA counterparts. The presence of rib fractures alongside other thoracic injuries, such as lung injury, pneumothorax, or hemothorax, was strongly correlated with BTAI in patients following skiing accidents (OR = 128.5). Conclusions: The injury severities and locations of BTAI in SA patients were comparable to those in MVA patients, indicating similar mechanisms of thoracic trauma. However, the SA patients experienced fewer concurrent pelvic and extremity fractures, had less post-procedural morbidity, and required shorter ICU stays. The presence of rib fractures combined with other thoracic injuries strongly suggests BTAI. These indicators should lead to prompt imaging and appropriate therapy. Full article

(This article belongs to the Special Issue Current Trends in Vascular and Endovascular Surgery)

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13 pages, 2821 KiB

Open AccessArticle

Dynamic Radial MR Imaging for Endoleak Surveillance after Endovascular Repair of Abdominal Aortic Aneurysms with Inconclusive CT Angiography: A Prospective Study

by Haidara Almansour, Migdat Mustafi, Mario Lescan, Ulrich Grosse, Mateja Andic, Jörg Schmehl, Christoph Artzner, Gerd Grözinger and Sven S. Walter

J. Clin. Med. 2024, 13(10), 2913; https://doi.org/10.3390/jcm13102913 - 15 May 2024

Cited by 1 | Viewed by 937

Abstract

Background/Objectives: To assess free-breathing, dynamic radial magnetic resonance angiography (MRA) for detecting endoleaks post-endovascular aortic repair (EVAR) in cases with inconclusive computed tomography angiography (CTA). Methods: This prospective single-center study included 17 participants (mean age, 70 ± 9 years; 13 males) who underwent dynamic radial MRI (Golden-angle RAdial Sparse Parallel-Volumetric Interpolated BrEath-hold, GRASP-VIBE) after inconclusive multiphasic CT for the presence of endoleaks during the follow-up of EVAR-treated abdominal aortic aneurysms. CT and MRI datasets were independently assessed by two radiologists for image quality, diagnostic confidence, and the presence/type of endoleak. Statistical analyses included interrater and intermethod agreement, and diagnostic performance (sensitivity, specificity, area under the curve (AUC)). Results: Subjective image analysis demonstrated good image quality and interrater agreement (k ≥ 0.6) for both modalities, while diagnostic confidence was significantly higher in MRA (p = 0.03). There was significantly improved accuracy for detecting type II endoleaks on MRA (AUC 0.97 [95% CI: 0.87, 1.0]) compared to CTA (AUC 0.66 [95% CI: 0.41, 0.91]; p = 0.03). Although MRA demonstrated higher values for sensitivity, specificity, AUC, and interrater agreement, none of the other types nor the overall detection rate for endoleaks showed differences in the diagnostic performance over CT (p ≥ 0.12). CTA and MRA revealed slight to moderate intermethod concordance in endoleak detection (k = 0.3–0.64). Conclusions: The GRASP-VIBE MRA characterized by high spatial and temporal resolution demonstrates clinical feasibility with good image quality and superior diagnostic confidence. It notably enhances diagnostic performance in detecting and classifying endoleaks, particularly type II, compared to traditional multiphase CTA with inconclusive findings. Full article

(This article belongs to the Special Issue Current Trends in Vascular and Endovascular Surgery)

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14 pages, 2317 KiB

Open AccessArticle

Bypass Patency and Amputation-Free Survival after Popliteal Aneurysm Exclusion Significantly Depends on Patient Age and Medical Complications: A Detailed Dual-Center Analysis of 395 Consecutive Elective and Emergency Procedures

by Hannah Freytag, Marvin Kapalla, Floris Berg, Hans-Christian Arne Stroth, Tessa Reisenauer, Kerstin Stoklasa, Alexander Zimmermann, Christian Reeps, Christoph Knappich, Steffen Wolk and Albert Busch

J. Clin. Med. 2024, 13(10), 2817; https://doi.org/10.3390/jcm13102817 - 10 May 2024

Viewed by 1082

Abstract

Background/Objectives: A popliteal artery aneurysm (PAA) is traditionally treated by an open PAA repair (OPAR) with a popliteo–popliteal venous graft interposition. Although excellent outcomes have been reported in elective cases, the results are much worse in cases of emergency presentation or with the necessity of adjunct procedures. This study aimed to identify the risk factors that might decrease amputation-free survival (efficacy endpoint) and lower graft patency (technical endpoint). Patients and Methods: A dual-center retrospective analysis was performed from 2000 to 2021 covering all consecutive PAA repairs stratified for elective vs. emergency repair, considering the patient (i.e., age and comorbidities), PAA (i.e., diameter and tibial runoff vessels), and procedural characteristics (i.e., procedure time, material, and bypass configuration). Descriptive, univariate, and multivariate statistics were used. Results: In 316 patients (69.8 ± 10.5 years), 395 PAAs (mean diameter 31.9 ± 12.9 mm) were operated, 67 as an emergency procedure (6× rupture; 93.8% severe acute limb ischemia). The majority had OPAR (366 procedures). Emergency patients had worse pre- and postoperative tibial runoff, longer procedure times, and more complex reconstructions harboring a variety of adjunct procedures as well as more medical and surgical complications (all p < 0.001). Overall, the in-hospital major amputation rate and mortality rate were 3.6% and 0.8%, respectively. The median follow-up was 49 months. Five-year primary and secondary patency rates were 80% and 94.7%. Patency for venous grafts outperformed alloplastic and composite reconstructions (p < 0.001), but prolonged the average procedure time by 51.4 (24.3–78.6) min (p < 0.001). Amputation-free survival was significantly better after elective procedures (p < 0.001), but only during the early (in-hospital) phase. An increase in patient age and any medical complications were significant negative predictors, regardless of the aneurysm size. Conclusions: A popliteo–popliteal vein interposition remains the gold standard for treatment despite a probably longer procedure time for both elective and emergency PAA repairs. To determine the most effective treatment strategies for older and probably frailer patients, factors such as the aneurysm size and the patient’s overall condition should be considered. Full article

(This article belongs to the Special Issue Current Trends in Vascular and Endovascular Surgery)

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10 pages, 1041 KiB

Open AccessArticle

Retrograde Peroneal Artery Approach to Treat Infra-Inguinal Arterial Chronic Total Occlusions: A Multicentre Experience and Technical Considerations

by Lorenzo Patrone, Gianmarco Falcone, Raphael Coscas, Hady Lichaa, Muliadi Antaredja, Fabrizio Fanelli and Erwin Blessing

J. Clin. Med. 2024, 13(10), 2770; https://doi.org/10.3390/jcm13102770 - 8 May 2024

Viewed by 1531

Abstract

Background/Objectives: Retrograde access of the peroneal artery (PA) is considered technically challenging and at risk of bleeding. The aim of this multicentre retrospective study was to assess the safety, feasibility, and technical success of this access route for infrainguinal endovascular recanalizations. Methods: We retrospectively analyzed 186 consecutive patients treated over a 7-year period (May 2014–August 2021) who underwent endovascular recanalization of infra-inguinal lesions using a PA access route. In all cases, retrograde PA access was obtained following a failed attempt to cross the occlusion via the antegrade route. Results: Among the 186 patients, 120 were males (60.5%) and the mean age was 76.8 ± 10.7 years old (44–94 years). One hundred and thirteen patients (60.7%) suffered from chronic limb threatening ischemia (CLTI). All patients presented with chronic total occlusions (CTO) and a failed conventional antegrade recanalization attempt. Retrograde access was performed under angiographic guidance in 185 cases (99.5%). It was successfully established in 171 cases (91.9%). The total rate of retrograde puncture-related complications was 2.1% (two puncture site bleedings of which one necessitated fasciotomy and two cases of arteriovenous fistulas managed conservatively). The Major Adverse Event (MAE) rate at 30 days was 1.6% (3/186). Conclusions: Retrograde recanalization of challenging infra-inguinal lesions via PA is safe and effective in experienced hands. Full article

(This article belongs to the Special Issue Current Trends in Vascular and Endovascular Surgery)

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13 pages, 1236 KiB

Open AccessArticle

Elevated Leukocyte Glucose Index Is Associated with Long-Term Arteriovenous Fistula Failure in Dialysis Patients

by Adrian Vasile Mureșan, Elena Florea, Emil-Marian Arbănași, Réka Bartus, Eliza-Mihaela Arbănași, Alexandru Petru Ion, Bogdan Andrei Cordoș, Vasile Bogdan Halatiu, Raluca Niculescu, Adina Stoian, Claudiu Constantin Ciucanu and Eliza Russu

J. Clin. Med. 2024, 13(7), 2037; https://doi.org/10.3390/jcm13072037 - 1 Apr 2024

Cited by 1 | Viewed by 1440

Abstract

(1) Background: Arteriovenous fistula (AVF) is the preferred type of vascular access for dialysis in patients with end-stage kidney disease (ESKD). However, the primary patency of AVF at one year is under 70% due to several risk factors and comorbidities. Leukocyte glucose index (LGI), a new biomarker based on blood leukocytes and glucose values, has been found to be associated with poor outcomes in cardiovascular disease. The aim of this study is to analyze the impact of LGI on the long-term primary patency of AVF following dialysis initiation. (2) Methods: We conducted a retrospective observational study in which we initially enrolled 158 patients with ESKD admitted to the Vascular Surgery Department of the Emergency County Hospital of Targu Mures, Romania, to surgically create an AVF for dialysis between January 2020 and July 2023. The primary endpoint was AVF failure, defined as the impossibility of performing a chronic dialysis session due to severe restenosis or AVF thrombosis. After follow-up, we categorized patients into two groups based on their AVF status: “functional AVF” for those with a permeable AVF and “AVF failure” for those with vascular access dysfunction. (3) Results: Patients with AVF failure had a higher prevalence of atrial fibrillation (p = 0.013) and diabetes (p = 0.028), as well as a higher LGI value (1.12 vs. 0.79, p < 0.001). At ROC analysis, LGI had the strongest association with the outcome, with an AUC of 0.729, and an optimal cut-off value of 0.95 (72.4% sensitivity and 68% specificity). In Kaplan–Meier survival analyses, patients in the highest tertile (T3) of LGI had a significantly higher incidence of AVF failure compared to those in tertile 1 (p = 0.019). Moreover, we found that patients with higher baseline LGI values had a significantly higher risk of AVF failure during follow-up (HR: 1.48, p = 0.003). The association is independent of age and sex (HR: 1.65, p = 0.001), cardiovascular risk factors (HR: 1.63, p = 0.012), and pre-operative vascular mapping determinations (HR: 3.49, p = 0.037). (4) Conclusions: In conclusion, high preoperative values of LGI are positively associated with long-term AVF failure. The prognostic role of the biomarker was independent of age, sex, cardiovascular risk factors, and pre-operative vascular mapping determinations. Full article

(This article belongs to the Special Issue Current Trends in Vascular and Endovascular Surgery)

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12 pages, 6790 KiB

Open AccessArticle

Accuracy and Sterilizability of In-House Printed Patient-Specific Aortic Model for Surgeon-Modified Stent Grafts—A Workflow Description for Emergency Aortic Endovascular Procedures

by Max Wilkat, Julian Lommen, Majeed Rana, Norbert Kübler, Tobias Wienemann, Sönke Maximilian Braß, Reinhold Thomas Ziegler, Agnesa Mazrekaj, Artis Knapsis, Hubert Schelzig, Markus Udo Wagenhäuser and Amir Arnautovic

J. Clin. Med. 2024, 13(5), 1309; https://doi.org/10.3390/jcm13051309 - 26 Feb 2024

Cited by 1 | Viewed by 971

Abstract

Introduction: The use of 3D-printed aortic models for the creation of surgeon-modified endoprostheses represents a promising avenue in aortic surgery. By focusing on the potential impact of sterilization on model integrity and geometry, this report sheds light on the suitability of these models for creating customized endoprostheses. The study presented here aimed to investigate the safety and viability of 3D-printed aortic models in the context of sterilization processes and subsequent remodeling. Methods: The study involved the fabrication of 3D-printed aortic models using patient-specific imaging data and established additive manufacturing techniques. Five identical aortic models of the same patient were printed. Two models were subjected to sterilization and two to disinfection using commonly employed methods, and one model remained untreated. The models were checked by in-house quality control for deformation (heat map analyses) after the sterilization and disinfection processes. Three models (sterilized, disinfected, and untreated) were sent for ex-house (Lufthansa Technik, AG, Materials Technologies and Central Laboratory Services, Hamburg, Germany) evaluation and subsequent quantification of possible structural changes using advanced imaging and measurement technologies (macroscopic and SEM/EDX examinations). After sterilization and disinfection, each aortic model underwent sterility checks. Results: Based on macroscopic and SEM/EDX examinations, distinct evidence of material alterations attributed to a treatment process, such as a cleaning procedure, was not identified on the three implants. Comparative material analyses conducted via the EDX technique yield consistent results for all three implants. Disinfected and sterilized models tested negative for common pathogens. Conclusions: The evaluation of 3D-printed aortic models’ safety after sterilization as well as their suitability for surgeon-modified endoprostheses is a critical step toward their clinical integration. By comprehensively assessing changes in model integrity and geometry after sterilization, this research has contributed to the broader understanding of the use of 3D-printed models for tailor-made endovascular solutions. As medical technologies continue to evolve, research endeavors such as this one can serve as a foundation for harnessing the full potential of 3D printing to advance patient-centered care in aortic surgery. Full article

(This article belongs to the Special Issue Current Trends in Vascular and Endovascular Surgery)

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6 pages, 610 KiB

Open AccessBrief Report

Pain after 1940 nm Laser for Unilateral Incompetence of the Great Saphenous Vein

by Torsten Willenberg, Simon Bossart, Michael Schubert, Sarvesh Ghorpade and Axel Haine

J. Clin. Med. 2024, 13(13), 3839; https://doi.org/10.3390/jcm13133839 - 29 Jun 2024

Viewed by 785

Abstract

Background: To investigate postprocedural pain after using an endovenous 1940 nm laser for great saphenous vein incompetence. Methods: A total of 72 patients were treated for symptomatic unilateral great saphenous incompetence using a 1940 nm laser device. All patients were treated using a standardized procedure under local anesthesia and investigated for postprocedural pain for 4 weeks using a visual analog scale (VAS 0-10). Results: Moderate pain was reported. A total of 17 patients reported minor scale 1 after the first day. On average, pain regressed to minor 1 after day 6. No significant complications were observed. Conclusions: Our results support the atraumatic character of this higher wavelength laser. In terms of patient comfort, higher wave lengths such as 1940 nm should be preferred for endovenous laser ablation. Using a combination of wavelengths could be the future solution to providing both safe ablation and minimum postprocedural pain. Full article

(This article belongs to the Special Issue Current Trends in Vascular and Endovascular Surgery)

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