Endovenous laser treatment of saphenous veins: is there clinical difference using different endovenous laser wavelenghts?

Endovenous laser treatment (EVLT) is an efficient method to treat incompetent saphenous veins with high occlusion rates. Major side effects reported with 810 nm and 980 nm diode laser are postoperative pain and bruising. Recently laser systems with higher wavelengths (WSLWs), associated with new energy delivery devices, seem to reduce some side effects previously reported. Aim of this study is to verify if there are real clinical advantages in the use of WSLWs, reviewing the comparison studies present in the literature. After a search on MEDLINE database, a review of all papers concerning WSLWs, was made. Five studies of comparison between different wavelength, 810 vs.. 980 nm, 940 vs.. 1320 nm, 810 vs.. 1320 nm, 980 vs.. 1500 nm and 980 vs.. 1470 nm were found. These studies report similar results: the WSLWs produce fewer side effects. New optical fibers have also been developed; WSLWs with the use of these new fibers dramatically changed the postoperative period, with a reduction of pain and bruising. There is no scientific evidence that WSLWs have any effect on long-term outcome, although short-term differences have been found for some side effects. Other parameters are also important: in particular, LEED and cold tumescent anesthesia are critical points. Laser fiber design probably has a significant effect on treatment success in the performance of EVLT and also how the energy is delivered (pulsing or continuous mode) and the pull-back rate of the laser fiber are possible factors affecting complication ratios and pain scores, regardless of the type of wavelength used.