A newly published study in Phlebology: The Journal of Venous Disease offers compelling evidence that challenges prevailing assumptions about energy variability in endovenous laser ablation (EVLA) procedures using different power delivery modes. Conducted by Oscar F. Berhanu and Professor Mark S. Whiteley of The Whiteley Clinic, the research provides critical insights into the actual energy output delivered during EVLA treatments, shedding light on the reliability of the technology in both continuous and pulsed applications.
EVLA is a widely established treatment for venous insufficiency, especially in truncal veins. While the procedure is typically performed using a continuous power mode combined with a steady pull-back technique, clinicians also employ pulsed energy modes in more anatomically sensitive areas such as short veins, incompetent perforators, or neovascular tissue. Pulsed delivery in these cases aims to minimize thermal spread and better preserve surrounding structures. However, concerns have persisted that the ramp-up time inherent in pulsed modes may lead to a reduction in the total energy delivered, potentially affecting clinical outcomes.
To investigate this, the study evaluated energy emission using a 1470 nm diode laser with a 600-micron radial fibre under three distinct settings: continuous power at 10 watts, pulsed power with a 1-second on/1-second off cycle, and pulsed power with a 0.5-second on/1-second off cycle. Each setting was tested in five trials, with real-time power output recorded every 0.1 seconds.
Despite anticipated lower peak readings in the pulsed modes—attributed to delayed ramp-up—each method delivered approximately 94% of the target 100-joule energy. Notably, the research identified that the lag in reaching peak power was not a limitation of the laser itself but rather a reflection of the response time of the power meter and sensor used in the measurements. This distinction is important, as it may lead to misinterpretations of laser performance during procedures if instrumentation delay is not considered.
The findings confirm that EVLA consoles are capable of delivering consistent total energy irrespective of whether the laser is operated in continuous or pulsed mode. This reinforces the technology’s reliability and precision, even when used in short, intermittent bursts—an important consideration for treatments involving anatomically delicate or thermally sensitive areas.
Professor Mark S. Whiteley, a globally recognized consultant venous surgeon and founder of The Whiteley Clinic in the UK, continues to lead innovation in vein treatment. His co-author, Oscar F. Berhanu, contributes significantly to the clinic’s ongoing research in advancing venous disease management.
