We conducted a blind randomized comparative study of the efficacy and course of the early postoperative period after obliteration of BPV with a SPS diameter of more than 15 mm and a BPV trunk diameter of more than 10 mm. To obliterate the BPV, we used DIOMAX lasers with a wavelength of 980 nanometers and biolitec lasers with a wavelength of 1470 nanometers. The third technique we used was RF with Covidien’s Closure FAST technology.
In total, 60 people participated in the study, who were divided into three clinical groups of 20 people each, randomization was carried out in such a way that half of the patients in each group had a diameter of SPS of more than 20 mm, and a diameter of BPV of more than 15 mm. All interventions were performed under standard tumescent anesthesia using one of these three technologies.
The power of laser exposure in both the first and second groups was 15 watts. With a SPS diameter of more than 20 mm and a BPV diameter of more than 15 mm, the density of the supplied laser energy was selected by reducing the traction speed of the laser light guide, focusing on the appearance of ultrasonic signs of BPV obliteration. In some cases, this approach required reducing the traction speed of the fiber in the near-mouth zone to 1 mm in 3 seconds, which, according to the data shown on the laser monitor, corresponded to an energy density of 240 J. When performing RF, it was sometimes necessary to perform up to 6 standard cycles of 20 s.
After the procedure, small doses of NSAIDs, venotonics, round-the-clock elastic compression with 2nd class knitwear were prescribed for a week. All patients were examined by an independent phlebologist who did not have information about the method of venobliteration. After the obliteration, the VCSS scale was used to assess the clinical severity of the disease after 2 and 4 weeks. The quality of obliteration was also assessed after 2 and 4 weeks based on the results of ultrasound scanning. There were no complications in patients of all 3 groups.
In one case, after the RF procedure, an ungliterated BPV was determined in the patient during ultrasound scanning. When obliterating vessels with a diameter of more than 20 mm, there was no significant difference between the RF and the Ceralas laser with a wavelength of 1470 nanometers.
However, when performing RF in this category of patients, several standard cycles were required on one venous segment, which increased the time of surgical intervention. When obliterating vessels with a diameter of 15-20 mm SPS and a diameter of 10-15 mm BPV, there was no significant difference between all three methods used.