Mid-term and Long-term Outcomes of Endovenous Laser Ablation Utilizing a 1470 nm Laser a Systematic Review and Meta-Analysis.

Abstract

Purpose: We sought to investigate the mid-term and long-term efficacy of 1470 nm endovenous laser ablation (EVLA).

Material and methods: We conducted a systematic research on PubMed, Scopus, and Web of science for articles published by January 2024. The primary endpoints were truncal vein and great saphenous vein (GSV) occlusion.

Results: Fifteen studies, 4 randomized controlled trials (RCTs), 5 prospective, and 6 retrospective case series, including 2064 patients and 2125 truncal veins (1862 GSV) were included. The pooled truncal vein occlusion estimates at 2, 3, and 5 years were 93.51% (95% confidence interval [CI]: 90.01, 95.84), 89.60% (95% CI: 82.75, 93.93), 88.94% (95% CI: 81.59, 93.58). The pooled GSV occlusion at 2, 3, and 5 years were 93.90% (95% CI: 90.30, 96.21), 93.01% (95% CI: 82.80, 97.36), and 89.06% (95% CI: 80.55, 94.12), respectively. The pooled deep vein thrombosis (DVT) and burn estimates were 1.42% (95% CI: 0.87, 2.31) and 2.64% (95% CI: 1.19, 5.75), respectively. The pooled overall and permanent neurologic complication estimates were 4.33% (95% CI: 1.62, 11.12) and 1.70% (95% CI: 0.69, 4.13), respectively. The pooled Venous Clinical Severity Score (VCSS) reduction by the end of follow-up was, mean difference (MD), 4.96 (95% CI: 3.87, 6.05). Meta-regression analysis including linear endovenous energy density (LEED) values ranging from 69 to 101.7 J/cm elucidated a statistically significant positive association between LEED and GSV occlusion at the 2-year (β=0.0977, p=0.02), 3-year (β=0.2021, p<0.01) and 5-year (β=0.0534, p=0.01) follow-up intervals.

Conclusion: This review has displayed satisfactory medium and long-term truncal and GSV occlusion outcomes for the 1470 nm device. In addition, a positive association between GSV occlusion and LEED was identified, persisting through the 2-year, 3-year, and 5-year follow-up intervals. Despite these favorable findings further research is imperative, focusing not only on technical aspects, such as vein occlusion but also on critical clinical parameters, including varicose vein recurrence, to comprehensively evaluate the effectiveness and durability of EVLA.

Clinical impact: This review demonstrated the efficacy and safety of the 1470 nm EVLA device in the treatment of lower limb venous insufficiency over the medium- and long-term periods, further substantiating its continued use. Moreover, the consistent positive association between linear endovenous energy density (LEED) and occlusion outcomes across the five-year follow-up interval highlighted the critical role of LEED in optimizing long-term clinical results, potentially offering valuable insights for practitioners.