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BACKGROUND: Many patients complain of prominent vertical veins in the center of their forehead, worse when smiling, wrinkling the forehead in bright light, leaning forward, and when vasodilated in heat, when exercising, or with alcohol. Previous attempts to treat these with external laser, sclerotherapy, and phlebectomy have not been successful. OBJECTIVE: To describe a new method of treating prominent vertical forehead veins and to report the early results. MATERIALS AND METHODS: We used endovenous laser ablation with a 1470 nm diode laser in 15 patients (F:M 12:3; mean age 38.4 years range 24-69). A bare fiber was used once and a 400-µm single ring radial fiber (Biolitec, Vienna, Austria) in all other cases. Tumescence was placed around the vein and a power of 2 to 3 W with a pullback of 7 to 10 seconds per centimeter. RESULTS: Twelve of the 15 patients (80%) ended up with a good cosmetic result and were satisfied, although 2 needed redo treatment. One patient had minor skin tethering, and 2 (13%) suffered burns-one was the only bare fiber case and the other, the only one where 4 W was used. CONCLUSION: We present a novel technique to treat prominent vertical forehead veins, with apparently good early results.

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Resumo Contexto Existem diversas formas de tratamento de varizes de membros inferiores. Entre elas, destaca-se o uso do laser diodo de 1.470 nm. Essa técnica proporciona aos pacientes uma cirurgia em regime ambulatorial, com retorno precoce à atividade ocupacional, bom resultado estético e baixo índice de complicações. No entanto, ainda se discute exaustivamente variáveis como comprimento de onda do laser, potência aplicada em cada área, tipo de fibra, necessidade ou não de tumescência e densidade de energia endovenosa linear. Objetivos Analisar os resultados do tratamento da insuficiência venosa superficial com laser diodo de 1.470 nm. Métodos Estudo retrospectivo, realizado em uma clínica privada de um hospital privado em Florianópolis a partir de dados colhidos prospectivamente. As amostras eram de 287 pacientes submetidos à cirurgia para tratamento da insuficiência venosa superficial com laser diodo de 1.470 nm, de janeiro de 2016 a dezembro de 2018, totalizando 358 veias safenas magnas e 84 veias safenas parvas tratadas. Resultados A taxa de oclusão total após 12 meses de cirurgia foi de 94,4%, com densidade de energia endovenosa linear média de 45,90 J/cm nas veias safenas magnas e de 96,4% com densidade de energia endovenosa linear média de 44,07 J/cm nas veias safenas parvas. Conclusões No período acompanhado, o laser diodo de 1.470 nm mostrou-se um tratamento seguro, muito efetivo e com baixas taxas de complicações (dor, edema, equimose, trombose venosa profunda e trombose induzida pelo calor endovenoso).

Abstract Background There are several ways to treat varicose veins of the lower limbs, among which use of 1470nm diode lasers stands out. This technique can be used to treat patients in outpatient settings, with early return to work, good esthetic results, and low rates of complications. However, variables such as the laser wavelength, the power administered in each area, the type of fiber, and the linear intravenous energy density (LEED) are still extensively discussed. Objectives To analyze the results of superficial venous insufficiency treatment with a 1470nm diode laser. Methods Retrospective study conducted at a private clinic in a private hospital in Florianopolis, based on a database collected prospectively. The sample comprised 287 patients who underwent surgery to treat superficial venous insufficiency with 1470nm diode laser, from January 2016 to December 2018, totaling 358 great saphenous veins (GSVs) and 84 small saphenous veins (SSVs) treated. Results The total occlusion rates after 12 months of surgery were 94.4% in the GSVs, with an average LEED of 45.90 J/cm, and 96.4% in the SSVs, with an average LEED of 44.07 J/cm. Conclusions During the follow-up period, the 1470nm diode laser proved to be a safe treatment, with great efficacy and low rates of complications (pain, edema, bruising, deep vein thrombosis, and endothermal heat-induced thrombosis - EHIT).

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Objectives To determine great saphenous vein occlusion rate after endovenous laser ablation using the 1470-nm bare-fiber diode laser to supply either 7 W or 15 W and evaluate procedure-related complications. Method Patients with varicose veins of the lower extremities (CEAP class C2-C6) were randomly assigned to undergo either 7-W (18 patients, 30 limbs) or 15-W (18 patients, 30 limbs) endovenous laser ablation. Duplex ultrasound follow-up was at 3-5 days, 1, 6, and 12 months postoperatively. Results Occlusion rate was 100% in both groups at 3-5 days and 1 month and 86.7% in 7-W and 100% in 15-W patients at both 6 and 12 months, with no difference between groups ( p > 0.05). Four (13.3%) 15-W and 3 (10%) 7-W patients had paresthesia at 3-5 days, with no difference between groups ( p > 0.05). Conclusions These preliminary data suggest that both techniques are similarly effective in the treatment of varicose great saphenous veins.

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OBJECTIVE: This study evaluated the safety and clinical and anatomic effectiveness of endovenous laser therapy (EVLT) and microphlebectomy in the treatment of varicose veins secondary to saphenous reflux. METHODS: From January 1, 2005, to December 31, 2007, 1985 EVLT procedures were performed in 1559 eligible patients (1263 women) with a mean age of 52.8 years (range, 18-89 years). A 810-nm diode laser and microphlebectomy were used. All sites of superficial axial reflux above and below the knee were ablated. Symptoms of venous insufficiency were present in 97%, and 102 patients (6.54%) had an open ulcer when they underwent operation. Patients had clinical follow-up visits, including duplex ultrasound examination, at 1 week, 1 month, 3 months, and yearly and were assessed for deep venous thrombosis (DVT), recanalization of the ablated vein, nerve injury, ulcer healing, and resolution of symptoms. RESULTS: A total of 1652 great saphenous veins (83.22%), 285 small saphenous veins (14.36%), 40 anterolateral tributaries (2.02%), and 8 posteromedial tributaries (0.40%) were ablated. An average of 19 phlebectomies were performed per case treated (range, 1-58). The primary ablation rate at 15 and 30 months was 91.26% and 78.25% by Kaplan-Meier analysis. Recanalization occurred in 35 veins (1.76%); in this group, 15 (42.9%) exhibited symptoms of venous insufficiency and were successfully closed with a second EVLT. Body mass index >30 kg/m(2) and a vein diameter >/=8.5 mm were the only factors predictive of recanalization. Postoperatively, the 102 ulcers showed healing at a mean of 5.2 weeks (range, 2-10 weeks), and only three reopened (2.94%). No major complications occurred. Two DVT (0.13%) occurred, but no pulmonary emboli or skin burns. Local transient paresthesia at the ankle and midcalf level occurred in 38 patients (2.43%). CONCLUSIONS: EVLT of all sites of superficial axial reflux above and below the knee and microphlebectomy demonstrated that the combined approach is safe and effective at eliminating reflux, affording symptomatic relief, and healing ulcers. It offers the additional advantage of resolving varicose veins and its cause in just one visit, leading to immediate better cosmetic results.

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BACKGROUND: Great saphenous vein (GSV) reflux is the most frequent form of venous insufficiency in symptomatic patients and is commonly responsible for varicose veins of the lower extremity. This non-randomized prospective controlled study was designed to test the hypothesis that 1) endovenous laser treatment is more effective than foam sclerotherapy in the closure of the refluxing GSV (as measured by degree of great saphenous vein reflux and venous clinical severity score changes) and 2) to record the associated complications of echo-guided endovenous chemical ablation with foam and endovenous laser therapy for the treatment of great saphenous vein reflux and to further identify risk factors associated with treatment failure. METHODS: Between January 1, 2006 and June 25, 2006, patients seeking treatment of varicose veins at a private practice of vascular medicine were assessed for the study. Inclusion criteria were: 1) presence of great saphenous vein reflux and 2) C2-6, Epr, A s, according to the CEAP classification. The selected patients consented into the study and were allowed to choose between foam (53 patients) or laser (45 patients) treatment. Duplex examinations were performed prior to treatment and at seven and 14 days, four weeks, six months, and one year after treatment. Venous clinical severity score was assessed pre-treatment and at one year post-procedure. RESULTS: The cohorts showed no statistically significant differences in age, sex, clinical and anatomical presentation, great saphenous vein diameter, and venous clinical severity score before the treatments. After one year follow up, occlusion of the great saphenous vein was confirmed in 93.4% (42/45) of limbs studied in the laser group and 77.4% (41/53) of limbs in the foam group (P < .0465). Venous clinical severity score significantly improved in both groups (P < .0001). Procedure associated pain was higher in the laser group (P < .0082). Induration, phlebitis, and ecchymosis were the most common complications. Logistical regression and subgroups analysis shown that a larger great saphenous vein diameter measured before treatment was associated with treatment failure in the foam (odds ratio 1.68, 95% CI 1.24-2.27, P < .0008) and in the laser group (odds ratio 1.91, 95% CI 1.02-3.59, P < .0428). A 90% treatment success is predicted for veins <6.5 mm in the foam group versus veins <12 mm in the laser group. CONCLUSIONS: Overall, endovenous laser ablation achieved higher occlusion rates than echo-guided chemical ablation with foam after one year follow-up. Matching the patient to the technique based on great saphenous vein diameter measured before treatment may assist in boosting the treatment success rate to >90%. A larger patient cohort followed and compared over a longer period of time would be required to confirm these findings.

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OBJECTIVE: Detailed here is an experimental model in monkeys of a new approach to treat hemorrhoids using a diode laser. BACKGROUND DATA: Hemorrhoids are a common source of pain and suffering. Endovascular laser therapy for variceal veins is a method that potentially could be used in the treatment of hemorrhoids. There is currently no such method described in the literature. MATERIALS AND METHODS: Hemorrhoids were induced in monkeys by ligation of the inferior hemorrhoidal vein, similar to their cause in humans. After the piles were identified, laser fibers were introduced into them, and they were irradiated with laser energy (810 nm at 1-2 W in 1-sec pulses of 1-2 J each, for a total fluency of 4-10 J). RESULTS: The piles were completely reduced, and histological examination performed 10 d post-surgery showed reduction of the dilated vessels and complete healing. The laser energy was not delivered directly into the veins, but instead to the surrounding submucosal interstitial tissue, effectively reducing the hemorrhoids. CONCLUSION: The diode laser energy delivered into the hemorrhoids led to their complete resolution. Further clinical trials using this protocol must be carried out to determine its applicability to human hemorrhoids.

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In-stent restenosis (ISR) when treated with balloon angioplasty (PTCA) alone, has a angiogrphic recurrence rate of 30%-85%. Ablating the hypertrophic neointimal tissue prior to PTCA is an attractive alternative, yet the late outcomes of such treatment have not been fully determined. This multicenter case control study assessed the angiographic and clinical outcomes of 157 consecutive procedures in 146 patients with ISR at nine institutions treated with either the PTCA alone (n=64)o excrimer laser assisted coronary angioplasty (ELCA, n=93) for ISR. Demographics were similar except more unstable angina at presentation in ELCA-treated patients (74.5% vs 63.5$; P=0.141). Lesions selected for ELCA were longer (16.8 +_ 11.2mm vs. 11.2+_ 8.6 mm;P < 0.001), more complex (ACC/AHA type C:35.1% vs. 13.6%;P<0.00001)...

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Atherobalation yields improved clinical results for balloon angioplasty (percutaneous transluminal coronary angioplasty, PTCA) in the treatment of diffuse in stent restenosis (ISR).We compared the mechanisms and clinical results of excrimer laser coronary angioplasty (ELCA)versus rotational atherectomy (RA), both followed by adjunct PTCA; 119 patients (158 ISR lesions) were treated with ELCA + PTCA and 130 patients (161 ISR lesions) were treated with RA + PTCA. Quantitative coronary angiographic and planar intravascular ultrasound (IVUS) measurements were performed routinely. In addition, volumetric (IVUS ELCA + PTCA, 14 RA + PTCA). There were no significant between-group differences in preintervention or final postintervention...

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O objetivo do trabalh e definir os metodos atualmente disponives para o tratamento da aterosclerose coronaria, bem como discutir suas indicacoes com base na experiencia obtida no HCPA, iniciada em 1986. Foram feitos ate o presente 1.330 procedimentos intervencionistas, desde angioplastia classica por cateter-balao (ACTP) ate os metodos alternativos, como aterectomia coronaria direcionada (ACD), a aterectomia coronaria rotacional (Rotablator), angioplastia coronaria por laser (Excimer-Laser) e a implantacao de "Stents" coronarios

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Os autores analisaram o efeito da iridectomia periférica em olhos com glaucoma pigmentar. Realizaram-se dois estudos com este objetivo: o primeiro, retrospectivo, comparava olhos de pacientes com glaucoma pigmentar bilateral que haviam sido submetidos à iridectomia periférica em apenas um dos olhos. O segundo, prospectivo e randomizado, comparava olhos submetidos ou näo à iridectomia periférica. O estudo retrospectivo mostrou que os olhos submetidos à iridectomia apresentaram uma mudança significativa da configuraçäo da íris periférica, além de reduçäo da pigmentaçäo da malha trabecular e do fuso de Krukenberg. O estudo prospectivo demonstrou um estreitamento do ângulo dos olhos submetidos à iridectomia, o que foi constatado através de uso de instrumento de análise computadorizada do segmento anterior. Demonstramos pela primeira vez que a iridectomia periférica em pacientes com glaucoma pigmentar pode promover uma alteraçäo da configuraçäo angular e pode reduzir a dispersäo pigmentar. Um maior período de seguimento será necessário para avaliar os efeitos sobre a pressäo intra-ocular e a progressäo do dano glaucomatoso ao nervo ótico.

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The efficacy of any method of transluminal angioplasty has been evaluated with angiography, this can show the major anatomic results. Angioscopy can detect by direct observation, the induced changes in the vessel wall morphology after the recanalization method. We studied 5 coronary arteries and 9 peripheral arteries with total occlusion in 7, and the other 7 with more than 75% of obstruction. All of them were evaluated with angiography and angioscopy, before and after the transluminal angioplasty. Eleven of the arteries were treated by transluminal ultrasound angioplasty, we obtained recanalization in 90% of them, in 6 (55%) of this we found angioscopic evidence of dissection in variable degrees. Two cases were treated only with balloon angioplasty, and the angioscopy image was of dissection too. In the only case of laser angioplasty we observed dark brown coloration in the treated lesion suggesting carbonization changes. The initial angiography analysis did not suggest the presence of complication of the atheroma plaque. However in 21% of the cases the angioscopy inspection demonstrated and hemorrhagic dye of the endothelium, and thrombosis in situ in 29%. We no found correlation in angiography and angioscopy aspect in 25% of the cases. Some of the endothelial alterations that can not be detectable by angiography, can be demonstrated by angioscopy, this changes could improve the appreciation of any recanalization method results, that could suggest its possible immediate and late complications.

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Las arteriopatías oclusivas periféricas son importantes como causa de padecimiento crónico y por la posibilidad de llevar a la amputación y aun a la muerte. Es escasa la información epidemiológica sobre la magnitud de estas enfermedades. Para conocer su frecuencia en nuestro país y algunos factores relacionados con repercusión de la enfermedad y con la demanda de servicios de atención médica, el Centro de Investigaciones Epidemiológicas (CIE) de la Academia Nacional de Medicina de Buenos Aires, Argentina, realizó un estudio colaborativo en organizaciones dedicadas a la atención médica en los cuales se registraron y se auditan las para estudios y tratamientos especiales. Estas órdenes fueron usadas como instrumento para detectar casos. El Servicio Social para Jubilados (PAMI) elegido para el estudio, tiene una "población" de más de 3 millones de personas, de las cuales hay mayoría de mujeres. Una encuesta en las órdenes para estudios/tratamientos, durante un período de 10 meses, permitió identificar 2.679 casos, de los cuales 72 por ciento eran varones y sus edades variaban desde 21 hasta 95 años. Se hallaron 4 diagnósticos: Arterioesclerosis 58,7 por ciento, Gangrena arterioesclerótica 20,3 por ciento, Angiopatía diabética 8,8 por ciento y Gangrena diabética 12,2 por ciento. La proporción de estudios (no invasivos o invasivos) y de tratamientos (médicos o quirúrgicos) así como de algunos procedimientos especiales fueron tabulados según sexo, edad y diagnóstico. Se halló diabetes en 21,1 por ciento de los casos (18,7 por ciento en varones y 27,2 por ciento en mujeres). Las tasas de prevalencia específicas (por mil) para sexo y edad variaban en los varones desde 0,001 en edad 21-30 hasta 2,285 en edad 66-70, y en las mujeres, desde 0,022 en edad 21-30 hasta 0,618 en edad 76-80

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Las arteriopatías oclusivas periféricas son importantes como causa de padecimiento crónico y por la posibilidad de llevar a la amputación y aun a la muerte. Es escasa la información epidemiológica sobre la magnitud de estas enfermedades. Para conocer su frecuencia en nuestro país y algunos factores relacionados con repercusión de la enfermedad y con la demanda de servicios de atención médica, el Centro de Investigaciones Epidemiológicas (CIE) de la Academia Nacional de Medicina de Buenos Aires, Argentina, realizó un estudio colaborativo en organizaciones dedicadas a la atención médica en los cuales se registraron y se auditan las para estudios y tratamientos especiales. Estas órdenes fueron usadas como instrumento para detectar casos. El Servicio Social para Jubilados (PAMI) elegido para el estudio, tiene una "población" de más de 3 millones de personas, de las cuales hay mayoría de mujeres. Una encuesta en las órdenes para estudios/tratamientos, durante un período de 10 meses, permitió identificar 2.679 casos, de los cuales 72 por ciento eran varones y sus edades variaban desde 21 hasta 95 años. Se hallaron 4 diagnósticos: Arterioesclerosis 58,7 por ciento, Gangrena arterioesclerótica 20,3 por ciento, Angiopatía diabética 8,8 por ciento y Gangrena diabética 12,2 por ciento. La proporción de estudios (no invasivos o invasivos) y de tratamientos (médicos o quirúrgicos) así como de algunos procedimientos especiales fueron tabulados según sexo, edad y diagnóstico. Se halló diabetes en 21,1 por ciento de los casos (18,7 por ciento en varones y 27,2 por ciento en mujeres). Las tasas de prevalencia específicas (por mil) para sexo y edad variaban en los varones desde 0,001 en edad 21-30 hasta 2,285 en edad 66-70, y en las mujeres, desde 0,022 en edad 21-30 hasta 0,618 en edad 76-80

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