By: Thomas M. Proebstle, M.D. Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.

1. Disclosure
Thomas M. Proebstle, M.D.
I disclose the following financial relationship(s):
•Consultant/Advisory Board: Sapheon

2. How do
Laser Wavelengths and Fibers
Differ Clinically?
Thomas M Proebstle

3. Thermal Ablation
Heat Delivery Technology and Technique
> 10 years: RF old style (RF-current)
810, 940, 980 nm diode lasers
1064, 1320 nm Nd:YAG lasers
< 5 years: RF-Segmental (conductive heat transfer)
1470 nm diode laser
pressurized overheated steam
New Fiber Tips: spherical, covered, radial
Hb H2O

4. Covered Fiber Tips
ceramics bare fiber tip
metal
radial

5. Clinical Impact of
Wavelengths and Fiber Tips
for Thermal Ablation?
How gentle can Heat Energy
be delivered to the Vein Wall ?

6. 810, 940, 980 nm diode lasers
1064, 1320 nm Nd:YAG lasers
1470 nm diode laser
Hb H2O

7. Data from Comparative Clinical Studies on the
Impact of Laser Wavelengths are very limited
Energy Dosing Issue is solved for all wavelengths
• Vein wall shrinkage maybe a surrogate marker for
sucessful energy transfer
Side Effect Profiles were in the Focus since then
• look at vein wall perforation and
treatment related side effects

9. 940 nm vs 1320 nm in vitro
Linear Endovenous Energy Density
940 nm: 15 W, 3 mm/s : 45 J/cm
30 W, 3 mm/s : 100 J/cm
1320 nm: 8 W, 1 mm/s : 80 J/cm
5 W, 0.5 mm/s: 100J/cm
1320 nm: no perforation
940 nm: perforation, carbonization
1320 nm 8 W, 1 mm/s control 5 W, 0.5 mm/s control
8 W, 1 mm/s control 5 W, 0.5 mm/s
20 mm 13 mm 8 mm
control 15 W 30 W
940 nm
1320 nm

10. 940 nm vs 1320 nm in vitro
Linear Endovenous Energy Density
940 nm: 15 W, 3 mm/s : 45 J/cm
30 W, 3 mm/s : 100 J/cm
1320 nm: 8 W, 1 mm/s : 80 J/cm
5 W, 0.5 mm/s: 100J/cm
1320 nm: no perforation
940 nm: perforation, carbonization
1320 nm 8 W, 1 mm/s control 5 W, 0.5 mm/s control
8 W, 1 mm/s control 5 W, 0.5 mm/s
20 mm 13 mm 8 mm
control 15 W 30 W
940 nm
1320 nm
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
0 50 100 150 200 250
linear endovenous energy density [Joule/cm]
veinshrinkage[%]
1320 nm
940 nm pulse
940 nm cw

11. RA Weiss, Dermatol Surg (2002) 28:56
RFA 1st generation versus 810 nm Diode Laser

12. Gentle ?

13. Clinical Influence of Wavelengths
Proebstle TM, Moehler T, Gül D, Herdemann S. Endovenous treatment of the great
saphenous vein using a 1,320 nm Nd:YAG laser causes fewer side effects than using
a 940 nm diode laser. Dermatol Surg. 2005;31:1678-83.
Bare Fiber
1320 nm less bruising, less induration, less pain and analgesics than 940 nm
Kabnick LS. Outcome of different endovenous laser wavelengths for
great saphenous vein ablation. J Vasc Surg. 2006; 43:88-93.
Bare Fiber
980 nm less bruising compared to 810 nm

14. Side effects -
percentage of affected limbs, median [maximum] duration in weeks
940 nm 30 Watt 1320 nm 8 Watt
No side effects 2% 18%
minor ecchymosis 81% 2 [ 4] 61% 2 [4]
any pain 81% 1.3 [12+] 50% 1.5 [2]
analgesics (diclofenac) 67% 0.3 [4] 36% 1 [2]
induration along vein 64% 4 [12+] 46% 2 [4]
phlebitis or periphlebitis 13% 1 [ 2] 7% 1.4 [2]
paresthesia 12% 4 [12+] 14% 1 [3]

15. Covered Fiber Tips
ceramics bare fiber tip
metal
radial
Impact of Fiber Tips ?

16. Clinical Impact of
Wavelengths and Fiber Tips
for Thermal Ablation?
How gentle can Heat Energy
be delivered to the Vein Wall ?

17. Segmental Ablation versus 980 nm Bare Fiber
Prospective Randomized Trials on Patients´ Recovery
Almeida JI et al. Radiofrequency endovenous ClosureFAST versus
laser ablation for the treatment of great saphenous reflux: a
multicenter, single-blinded, randomized study (RECOVERY study).
J Vasc Interv Radiol. 2009;20:752-9.
Shepherd AC et al. Randomized clinical trial of VNUS ClosureFAST
radiofrequency ablation versus laser for varicose veins.
Br J Surg 2010;97:810-8.
Segmental Thermal Ablation shows faster recovery
compared to 980 nm bare fiber ablation proven by
VCSS and QoL instruments

18. 1470 nm Radial versus Bare Fiber
Prospective Randomized Trials on Patients´ Recovery
Schwarz T, von Hodenberg E, Furtwängler C, Rastan A, Zeller T, Neumann FJ.
Endovenous laser ablation of varicose veins with the 1470-nm diode laser.
J Vasc Surg. 2010; 51:1474-8.
Less Bruising with Radial Fiber, also Lower LEED
Durability of results?

19. 1470 nm Radial versus 980 nm Bare Fiber
Prospective Randomized Trials on Patients´ Recovery
Doganci S, Demirkilic U. Comparison of 980 nm laser and bare-tip fibre with 1470 nm laser
and radial fibre in the treatment of great saphenous vein varicosities: a prospective
randomised clinical trial. Eur J Vasc Endovasc Surg. 2010;40:254-9.
Less side effects and better VCSS with 1470 nm Radial

20. 1470 nm Radial versus 980 nm Bare Fiber
Prospective Randomized Trials on Patients´ Recovery
Doganci S, Demirkilic U. Comparison of 980 nm laser and bare-tip fibre with 1470 nm laser
and radial fibre in the treatment of great saphenous vein varicosities: a prospective
randomised clinical trial. Eur J Vasc Endovasc Surg. 2010;40:254-9.
Less side effects and better VCSS with 1470 nm Radial

21. Covered Fiber Tips
ceramics bare fiber tip
metal
radial
How can Fiber Tips impact Side Effects?

22. cylindrical surface area A = 2 p r * h
surface of the CLF coil:
A = 0.23 cm * p * 7 cm = 5.06 cm²
estim. surface of the laser
emitting part of the radial fiber tip:
A = 0.12 cm * p * 0.2 cm = 0.075 cm²
surface of the laser emitting
section of the bare fiber tip A = p r²
A = (0.03 cm)² * p = 0.0028 cm²

23. cylindrical surface area A = 2 p r * h
surface of the CLF coil:
A = 0.23 cm * p * 7 cm = 5.06 cm²
estim. surface of the laser
emitting part of the radial fiber tip:
A = 0.12 cm * p * 0.2 cm = 0.075 cm²
surface of the laser emitting
section of the bare fiber tip A = p r²
A = (0.03 cm)² * p = 0.0028 cm²
factor 25
factor 65

24. cylindrical surface area A = 2 p r * h
surface of the CLF coil:
A = 0.23 cm * p * 7 cm = 5.06 cm²
estim. surface of the laser
emitting part of the radial fiber tip:
A = 0.12 cm * p * 0.2 cm = 0.075 cm²
surface of the laser emitting
section of the bare fiber tip A = p r²
A = (0.03 cm)² * p = 0.0028 cm²
factor 25
factor 65
Irradiance (10W)
I = 2.8 kW/cm²
Irradiance (10W)
I = 0.75 kW/cm²
Energy Flux aprox.
70 J/cm (in 20 s)

„I“ = (70J /20s)/(5.06/7)cm²
= o.oo5 kW/cm²

25. 980 nm Bare Fiber vs Metal-Shielded Tip
Consecutive patient cohorts
Prince EA, Soares GM, Silva M, Taner A, Ahn S, Dubel GJ, Jay BS. Impact of Laser Fiber
Design on Outcome of Endovenous Ablation of Lower-Extremity Varicose Veins: Results
from a Single Practice. Cardiovasc Intervent Radiol. 2010 Jun 17. [Epub ahead of print]
Partial Recanalization Rate (average 5 months follow-up) was
11.1% for metal-shielded, 2.3% for bare fiber treated GSVs
Company blames lack of metal tip covering
during first months of production of Fiber Kit

26. CONCLUSION
DATA on Clinical Impact of Wavelength are rare. With
sufficient energy Dosing any Wavelength can ablate the Vein.
LEED and EFE !
Fiber Tips seem to have Influence on Side Effect Profile
POWER Density