Compared to surgery EVLA is associated with faster recovery and fewer complications and recurrences may occur less frequently. Absorption by water lead to fewer side effects and might enhance the targeted tissue response. Water is the chromophore with the highest concentration in biological tissue, improved water absorption at 1940 NM might improve protective effects. Can the complete venous reflux pattern and all varicose veins be treated with endovenous technique including side branches, varicosities, perforators? Are there limitations concerning the diameter? Is varicose vein ablation in pronounced cases possible? What has to be considered in particular and which pitfalls should be avoided?

At our center we started total endovenous treatment eight years ago and have continuously perfected this technique. Approximately 1.400 legs are being treated per year using double ring radial fibers (outer diameter 1.25 / 1.5 mm, CEAP C 3 and >). The procedure is performed with direct puncture using 16 / 14 G cannula. A sequential puncture technique is used for tortuous side branches.

To illustrate the total endovenous technique, selected cases will be demonstrated and illustrated. Technical equipment: 2Ring 1.25 mm / 2Ring 1.5 mm, 1940 NM. The ablation of GSV/SSV, accessory veins, varicose veins and perforators (direct and indirect occlusion) will be explained. Photographic and ultrasound documentation will supplement the presentation. Sclerotherapy is the only additional treatment in the follow up.

Complete endovenous laser ablation (EVLA) of varicose veins with 1940 NM is effective and enables predictable functional and cosmetic results. A suitable LEED must be applied for successful and permanent occlusion (depending on: diameter, vein wall thickness and tissue response). Improved water absorption at 1940 NM might have positive effects with less complaints, faster vein resorption and less carbonization compared to 1470. Differences between 1470 and 1940 Nanometer is currently investigated in a prospective, randomized, multicenter and controlled study including our center.