Laser Skin Treatment at Boston MA

Laser skin treatment therapy or Endovenous Laser Ablation (EVLA) is performed by the
percutaneous insertion of a catheter that delivers thermal energy within the lumen of the
vein.

This thermal energy damages the endothelium and leads to occlusion and elimination of the
incompetent truncal vein from circulation. Lasers used for Laser skin treatment are diode
solid-state lasers with differing wavelengths. It is known that the laser thermal energy
induces a “boiling blood” effect within the vein lumen.

The laser-emitted wavelengths are absorbed by the hemoglobin of the red blood cells, leading
to steam bubble creation within the vein lumen. The absorption of the energy is via water and
not hemoglobin. This steam bubble creation is thought to induce conductive heat that results in
irreversible damage to the vein wall at the catheter tip and for an extended length within the
vein lumen.
This damage then causes the vein wall collagen to shrink, leading to luminal occlusion.
Dr.MUZZAMAL HABIB, MD at Boston Vein Care Boston MA efficiently uses and performs the
method of Laser Skin treatment also known as (EVLA) at his vein care center at Boston MA.

There is a linear effect with steam bubble creation and laser energy emitted, which does not
correlate with the laser wavelength. In a recent prospective, randomized trial comparing the
980 nm laser with the 1470 nm laser, it is reported reduced pain, ecchymosis, and
paresthesias along with improved patient satisfaction with the 1470 nm laser treatment.

A confounding variable was the different laser fiber on each catheter. Using a radial versus a
bare-tip fiber might also affect the outcomes. In all, the use of the Laser skin
treatment technique is efficacious regardless of the type of laser used, as long as the energy
delivered allows for the steam bubble reaction to occur to distribute heat within the vein
wall.

There is still debate on which wavelength used in Laser skin treatment provides the best
effect with the least post-operative bruising and pain.
Procedure Details
As with any endovenous procedure, preoperative vein DUS must be performed to identify
the refluxing vein and the extent of the vein that requires treatment.

Patient positioning, sterile preparation of the target limb, and ultrasound-guided venous
access are performed in the same manner as the above-described RFA procedure. After a 5F
sheath is placed in the vein, a .035-inch guidewire is then advanced to the common femoral
vein under direct ultrasound guidance.

Along 4F or 5F sheath is then advanced over the wire and positioned 1.5–2 cm below the
saphenofemoral junction. The laser catheter is then advanced over the wire to the end of the
long sheath.

For the diode laser, the sheath is then pulled back to expose the laser tip. For the Nd: YAG
laser, the entire long sheath is removed. The tumescent solution is then infiltrated in the
same manner and the same volume as recommended for the RFA procedure. Ultrasound
verification on the laser tip position is performed an additional time prior to activating the
laser.

The laser energy is then delivered while the operator continuously pulls back the catheter.
Each device manufacturer has instructions on the pull-back timing and amount of power
delivered. In general, the energy rate should be 50–80 joules/cm for successful closure of the
vein.

Following completion of the procedure, the catheter and sheath are removed and manual
pressure is held over the vein entry site. Compression wraps or class II compression garments
are then placed on the patient and recommended to be worn for at least one week following
the procedure.

The same postoperative precautions are recommended for the EVLA procedure as is for the
RFA procedure. The patient returns for a DUS to evaluate for vein closure and DVT at
approximately 72–96 hours post-procedure