Long Term Experience with CoolTouch 1320nm Endovenous Ablation

The first procedure to replace ligation and stripping of the great saphenous vein was radiofrequency mediated ablation. It gained FDA clearance in March 1999 as the Closure® procedure, and it was followed quickly by endovenous obliteration or ablation with lasers. None of these treatments was optimized initially but still were superior to more invasive stripping procedures. In 2003, however, we (Dr. M. Goldman as well) started thinking in terms of refining endovenous ablation in order to maximize success, increase patient comfort and improve safety. It was realized that the physics of laser tissue interaction and consideration of targeted chromophores was critical in designing a system to insure maximum efficacy, maximum patient comfort and lowest risks of side effects. While 810 nm was the laser endovenous technique initially introduced, (termed EndoVenous Laser Therapy or EVLT) it became clear that this wavelength was not optimized for the endovenous application because of relatively high absorption by hemoglobin. Other wavelengths such as 940 nm and 980 nm, also employed initially and in rapid succession, had similar absorption profiles by hemoglobin and were not optimal. We posed the question, “Why target hemoglobin when what we really want to do is heat the vein wall? Considering that the vein wall is comprised of collagen suspended in water, why heat hemoglobin when water-targeting wavelengths such as the 1320 nm CTEV were available for clinical development?”