Cor Vasa 2026, 68(3):259-263

Favorable Clinical Outcomes of Endovenous Laser Ablation (EVLA) Transform Surgery into Ambulatory Vascular Intervention: From Numerical Simulation to Optimized Clinical Practice

Michal Zelený^a, Vratislav Fabián^a, Vojtěch Horváth^{b, c}, Marek Šlais^{b, c}, Miroslav Vítovec^c, Ondřej Stehno^{b, c}, Petr Šedivý^{b, c}, Jiří Weiss^{b, c}, Jakub Honěk^{b, c}

^a Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, the Czech Republic

^b Motol and Homolka University Hospital, Prague, the Czech Republic

^c Avicena-chirurgie s.r.o., Prague, the Czech Republic

Objective: This study evaluates the efficacy and safety of the 1940 nm diode laser for endovenous laser ablation (EVLA) compared to 1064 nm and 1470 nm wavelengths. The objective was to validate the theoretical benefits of high water absorption at 1940 nm, specifically the confinement of heat distribution within the vein wall, by correlating long-term clinical outcomes with quantitative data from 3D numerical thermal modeling.

Methods: A prospective 15-year clinical registry (2010-2025) comprising 5,086 patients was analyzed, divided into sequential cohorts treated with 1064 nm (15 W), 1470 nm (10 W), and 1940 nm (8 W) lasers. Concurrently, a time-dependent 3D finite difference model based on the Pennes bioheat equation was developed to simulate heat distribution. The model quantified the cumulative thermal load on perivenous tissue and radial temperature profiles for each wavelength.

Results: Numerical simulations demonstrated that the 1940 nm wavelength reduced the perivenous thermal load by over 30-fold compared to 1064 nm, strictly confining heat to the target vein. Clinically, the 1940 nm protocol (8 W) achieved a venous closure rate >98%; equivalent to higher-power wavelengths despite a 50% reduction in power settings. This resulted in minimal postoperative pain and a low complication rate, with secondary follow-up visits required in only 4.4% of cases.

Conclusion: The 1940 nm wavelength optimizes selective photothermolysis by maximizing heat absorption within the vein wall. This allows for effective ablation at significantly lower power, ensuring procedural success while minimizing collateral thermal injury and improving patient comfort.

Keywords: Ambulatory surgery, Chronic venous insufficiency, Endovenous laser ablation, Numerical modeling, Varicose veins, 1940 nm diode laser

Received: March 19, 2026; Revised: March 19, 2026; Accepted: May 17, 2026; Prepublished online: June 2, 2012; Published: July 1, 2026  Show citation