Impact of Laser Wavelength on Outcomes of Flush Endovenous Laser Ablation: Comparative Evaluation of 1470 nm and 1940 nm Systems and Associated Complications.

BACKGROUND

Flush endovenous laser ablation (fEVLA) has been introduced as a modification of standard EVLA to minimize stump-related recurrence. While both 1,470-nm and 1,940-nm laser systems are widely used, their comparative performance in fEVLA remains insufficiently explored.

METHODS

This retrospective study included 277 patients treated with fEVLA for saphenous insufficiency between 2022 and 2025. Patients were categorized by laser wavelength: 1,470 nm (n = 100) and 1,940 nm (n = 177). Procedural parameters, linear endovenous energy density (LEED), complications, duplex-confirmed occlusion, recurrence, and quality-of-life outcomes (Chronic Venous Insufficiency Questionnaire-20 [CIVIQ-20], Venous Clinical Severity score [VCSS]) were evaluated.

RESULTS

The 1,940 nm group required significantly lower LEED across all venous segments (e.g., great saphenous vein right: 42 vs. 62 J/cm; P < 0.001). Postoperative complications, including ecchymosis, superficial thrombophlebitis, paresthesia, and hematoma, were more frequent in the 1,470 nm group. Pain scores at 6 hr were significantly lower with the 1,940-nm laser (3.5 ± 1.2 vs. 4.5 ± 1.8; P = 0.05). Early occlusion was 100% in both groups. Three recanalization events occurred during follow-up, with no significant difference between wavelengths. Both groups demonstrated comparable postoperative improvement in CIVIQ-20 and VCSS scores.

CONCLUSION

Both wavelengths achieved excellent early occlusion and symptom improvement. However, the 1,940-nm laser enabled effective fEVLA at significantly lower energy levels and was associated with fewer local complications, suggesting a safety advantage in early outcomes.