Comment to: Laser assisted foam sclerotherapy (LAFOS): a new approach to the treatment of incompetent saphenous veins, by Frullini A, Fortuna B. Phlébologie 2013;66:51-4.

For veins exceeding 1 cm of diameter, poorer outcome is expected as the occlusion rate of great or small saphenous veins (GSVs and SSVs, respectively). Reducing the diameter of the vein prior to sclerotherapy could improve the results, also requiring a limited volume of foam. A holmium:YAG (Ho:YAG) laser was employed to produce significant shrinkage on the vein media. This laser has been designed to avoid endothelium damaging while inducing coarctation of the vein wall by accumulating heat in the media (5 W, 500 mj, 350 µs max, 10 Hz max). The procedure under consideration – laser assisted foam sclerotherapy (LAFOS) – was applied in 50 patients (38 GSVs, mean diameter 9.17; 12 SSVs, mean diameter 7.91).
Veins were accessed by a 17 G short catheter with ultrasound (US) assistance. The laser fiber was placed 1-2 cm below the junction and manually retracted applying fluency from 150 to 400 mj without infiltration anesthesia. At the end of the laser phase, sclerosing foam (polidocanol: 3% GSV-5 mL mean; 2% SSV- 2 mL mean) was injected through the same catheter. One month of compression stockings was prescribed, with a 48-h-thigh eccentric compression by means of a pad. Patients were invited to walk daily for at least 1 h.
Vein shrinkage was constantly achieved and complete occlusion was always observed at 1 month. No patient referred extreme pain during laser procedure, while in 8 cases energy adjustment was required to avoid discomfort.