Hrev_master


                                                              Veins and Lymphatics 2015; volume 4:5531

                                       [Veins and Lymphatics 2015; 4:5531]                                                         [page 59]

Saphenous sparing laser 
modern options (comment 
to Gianesini et al., Veins 
and Lymphatics 2013;2:e21 
and Veins and Lymphatics
2015;4:5246)
Enrique Luis Ferracani
Private CVS surgeon, former chief of
Navy Hospital, Argentina

Dear Editor,
In your journal I really liked reading the

papers by Gianesini et al. Short endovenous
laser ablation of the great saphenous vein in a
modified CHIVA strategy,1 and Laser-assisted
strategy for reflux abolition in a modified
CHIVA approach.2

Saphenous sparing procedures demonstra-
ted competitive results whenever compared
with ablative ones.3,4

For this reason, in the last years I also expe-
rimented an innovative laser procedure with
the aim of sparing the saphenous vein.

The strategy is to reduce the enlarged great
saphenous vein calibre by creating only par-
tially shrunk rings of decreased calibre in the
preterminal valve region of the great saphe-
nous vein and then every 5 cm downward,
covering a total length of 20 cm (Figure 1). The
procedure is performed by a 1470 nm laser.

Neither crossectomy nor total vein occlusion is
done. In this way it is possible to spare the drai-
nage of the junctional tributaries and to avoid the
Receck paradox concerning the post-procedural
network predisposition to recurrence.5

Phlebectomy of the incompetent tributaries
along the leg completes the procedure.

The rings of decreased calibre constitute an
area of increased resistance, so counteracting
the reflux coming from the incompetent jun-
ction during the diastole. During the muscular
systole the flow accelerates through the redu-
ced calibres following the Castelli law, conse-
quently reducing the shear stress and thus the
inflammation on the vessel wall.

Technically these rings are created delive-
ring 24 J/cm. 

Up to now we treated 17 patients (C2-
4EpAsPr) presenting an incompetent sapheno-
femoral junction and a great saphenous vein
reflux, with a great saphenous vein junctional
calibre greater than 6 mm.

In a 3 years follow up we experienced 2
recurrences due to a hunterian and anterior
accessory sapheonus vein incompetence. In all
the other patients the sapheonus calibre
remained reduced without any detectable
reflux.

The procedure is performed in an operating
room, under sedation but without tumescence.  

We deliver 4 W for 6 s, never increasing the
leed over 24 J/cm in order to avoid an excessive
damage of the wall. 

After every ring shrunk a sonographic check
is performed. The targeted percentage reduc-
tion is 50% of the pre-operative calibre.

Following our oral presentation at the XV
Pan American Congress of Phlebology and
Lymphology of Lima Peru on May 13, 2012, our
work was awarded with the 1st prize of the  XX
Argentine and International Phlebology
Congress SAFYL 2013. We presented our preli-
minary experience also at the XVII World
Congress of the UIP Boston 2013 and publi-
shed the pilot study on the Journal of
Phlebology of the Argentinean Society.6

Correspondence: Enrique Luis Ferracani, Private
CVS surgeon, former chief of Navy Hospital,
Argentina.
E-mail: eferracani@gmail.com

Key words: Letter to editor; saphenous sparing
procedures.

Received for publication: 30 September 2015.
Accepted for publication: 30 September 2015.

This work is licensed under a Creative Commons
Attribution 3.0 License (by-nc 3.0).

©Copyright E.L. Ferracani, 2015
Licensee PAGEPress, Italy
Veins and Lymphatics 2015; 4:5531
doi:10.4081/vl.2015.5531

Figure 1. Rings of calibre reduction favoring a systolic anterograde flow and a diastolic
retrograde draining flow into a re-entry perforator.

No
n c

om
me

rci
al 

us
e o

nly



                             Letter to the Editor

[page 60]                                                          [Veins and Lymphatics 2015; 4:5531]

References

1. Gianesini S, Menegatti E, Zuolo M, et al.
Short endovenous laser ablation of the
great saphenous vein in a modified CHIVA
strategy.. Veins and Lymphatics 2013;
2:e21.

2. Gianesini S, Menegatti E, Zuolo M, et al.
Laser-assisted strategy for reflux abolition

in a modified  CHIVA approach. Veins and
Lymphatics 2015;4:5246.

3. Carandina S, Mari C, De Palma M, et al.
Varicose vein stripping vs haemodynamic
correction (CHIVA): a long term randomi-
sed trial. Eur J Vasc Endovasc Surg
2008;35:230-7.

4. Bellmunt-Montoya S, Escribano JM, Dilme J,
Martinez-Zapata MJ. CHIVA method for
the treatment of chronic venous insuffi-

ciency. Cochrane Database Syst Rev
2015;6:CD009648. 

5. Cestmir R. The hemodynamic paradox as a
phenomenon triggering recurrent reflux
in varicose vein disease. Int J Angiol
2012;21:181-6.

6. Ferracani E. Internal laser valvuloplasty and
venous remodeling using 1470laser. Initial
experience. Flebologia 2013;3:39-40.

No
n c

om
me

rci
al 

us
e o

nly