A report of an eight-year experience using diode laser for the treatment of congenital diffuse venous malformations, has shown the modality to be effective and safe with a low number of complications.
The experience from the Vascular Anomalies Unit in Hospital Universitario La Paz (Madrid, Spain) was presented at the European Society for Vascular Surgery’s annual meeting (ESVS; 25–28 September, Valencia, Spain) by Alexia Paluso (Hospital Universitario La Paz, Madrid, Spain). This work is part of a line of research on the treatment of diffuse venous malformations lead by Elena Marín Manzano.
According to Paluso, venous anomalies are the most frequent vascular anomalies. While they are benign, they affect young patients and grow as the patient does. They are associated with pain, oedema, deformity, venous stasis and thrombosis.
Some of the possible treatment options for venous malformations are surgery, which can be aggressive, requiring a large resection of tissue, with a high risk of bleeding and risk of injuring other surrounding tissues; and endovascular techniques, where the limiting condition of some agents resides in the high doses needed, due to the complex network these malformations have, and their toxic effect. On the other hand, Paluso noted, diode laser is a safe and effective treatment of which the mechanism of action is by thermal injury.
To come to that conclusion, the investigators reviewed patients with symptomatic congenital diffuse venous anomalies with an impact in their quality of life, treated at their centre between 2010 and 2018. The patients were treated with diode laser radial fibre (810–1470nm).
Data were registered in three categories, including that related to the patient (gender, age, type of vascular anomaly, location, symptoms), the procedure (anaesthesia, wavelength, power, energy), and to the outcome (visual analogue scale for pain, D-dimer, clinical improvement, complications, MRI).
All cases were performed under general anaesthesia and with percutaneous access. Only three cases needed open surgical access due to one hip replacement and two knee replacements simultaneously.
Overall, at their centre, the investigators have performed 26 procedures in 16 patients with a mean age of 30 years, 13 of whom were women. The most common symptom was pain (n=14), followed by deformity (n=3) and haemorrhage (n=3). The types of venous malformations included simple venous malformations (n=10), glomuvenous (n=3), capillary-venous (n=2) and capillary-lymphatic-venous (n=1).
“We found that we could perform repeated sessions of diode laser in patients, with no limitation on the number, and there is no limitation of whether the patient has been treated previously with another technique. The power we used was between 10–15W and the pain tested before and after the procedure had an overall tendency to decrease,” Paluso reported.
Further, she stated, the results showed pain reduction in 11 out of 16 patients and a visualised lesion size reduction in nine patients. In terms of complications, the investigators observed three skin burns with consequent cutaneous necrosis; and one sciatic nerve neuropathy, one false aneurysm and arteriovenous fistula which needed repairing.
“In conclusion, this technique is safe and effective and is well tolerated by patients who are discharged within 24 hours. It also reduces the size of the lesions and the associated symptoms. It can be combined with other techniques, such as sclerotherapy, surgery or embolisation. There are no reports on dose limitation or number of procedures, and there was a low number of complications,” Paluso said.
The study investigators are Alexia V Paluso Montero, Elena Marín Manzano, Covadonga Mendieta Azcona, Carlos Renato Jiménez Román, Teresa Hernández Ruiz, Marta Lavirgen Labrador, Beatriz Martínez Turégano and Juan Carlos López Gutiérrez.