Endovenous laser therapy of varicose veins - evidence and perspectives

Background. Endovenous laser therapy (ELT) has been used to treat patients suffering from saphenous vein insufficiency for approximately 15 years. Characteristic for EVT is a plethora of treatment protocols describing numerous different laser systems and application techniques. Efficacy and safety of this method was shown by many controlled studies and meta-analyses and several evidence-based treatment guidelines recommend ELT for treating saphenous vein insufficiency. Objectives. This article investigates the value of ELT compared to other forms of treatment and whether the method can be improved. Material and methods. An evaluation of numerous controlled studies and meta-analyses and several evidence-based treatment guidelines was carried out. Results and conclusion. Experimental studies as well as clinical data indicate that ELT may be further improved by specific measures, including (1) the use of laser generators with longer wavelengths, (2) the application of radially emitting fibers and (3) implementation of appropriate dose monitoring taking the size of treated veins into account. Nevertheless, more clinical studies are necessary to prove the efficacy of ELT and to compare it with other open surgical (e.g. crossectomy and saphenous vein stripping) and endovenous methods including mechanical, chemical, mechano-chemical and thermal techniques. This would serve to determine the optimal range of indications for each method.