Effects of low-energy EVLA with the use of a 1470-nm laser on vascular inflammation and remodeling parameters in patients with chronic venous disease.

Laser radiation involving the mid-infrared range of a 1470 nm wavelength (the "water", or W-laser) coincides with the absorption peak in water and is recognized as one the most effective methods for performing endovenous laser ablation (EVLA) of varicose veins in patients with chronic venous disease (CVD). The mechanism of action on the vein of laser radiation with a 1470 nm wavelength ensures direct action on all layers of the vein wall and thermal damage. This study was brought up to evaluate the effects of low-energy EVLA with the use of a 1470-nm laser with the average linear endovenous energy density (LEED) of 80 J/cm, on the key serum biomarkers of vascular inflammation and remodeling. We have additionally assessed patients' quality-of-life (QoL). To study the effects of low-energy EVLA with the use of a 1470-nm laser on vascular inflammation and remodeling parameters in patients with CVD. In this prospective cohort study subjects with symptomatic varicose veins, clinical class C2-C3 according to the CEAP classification (N = 95) were allocated non-randomly to four groups: group 1 - control (compression stockings only); group 2 - comparison (conservative treatment with micronized purified flavonoid fraction, MPFF); group 3 - EVLA with the use of a 1470-nm laser with the average LEED of 80 J/cm; group 4 - EVLA with a 1470-nm laser with the average LEED of 80 J/cm with adjuvant MPFF therapy. Serum levels of E-selectin, MCP-1, VEGF, MMP-2 were measured. Additionally, QoL analysis was performed using a CIVIQ-20 questionnaire. Treatments were associated with significant reductions in inflammatory biomarkers including E-selectin, MCP-1, and VEGF for MPFF (p < 0.001), and E-selectin, MCP-1 and MMP-2 for EVLA (p < 0.001). EVLA with the use of a 1470-nm laser with the average LEED of 80 J/cm with adjuvant MPFF therapy was associated with most notable reductions in all studied biomarkers (p < 0.001). CIVIQ-20 was improved by 23%, 29%, 36% and 40% at 2 months in groups 1, 2, 3, and 4, respectively. Performing endovenous laser ablation with the use of a 1470-nm laser with the average LEED of 80 J/cm in patients with chronic venous disease is associated with a statistically significant reduction in serum biomarkers of vascular inflammation and remodelling such as E-selectin, MCP-1, VEGF, MMP-2, as well as improvement in quality of life. Adjuvant therapy with MPFF on top of EVLA gives best results in terms of improved biochemistry and QoL.