Endovenous Laser Ablation for Varicose Veins: Wavelength Selection and Energy Delivery Optimization

Вступ

Endovenous thermal ablation has revolutionized the treatment of varicose veins, transitioning management from invasive surgical stripping to minimally invasive office-based procedures with superior patient comfort and comparable efficacy. Among thermal ablation modalities, endovenous laser ablation (EVLA) has emerged as one of the most widely adopted techniques, with approximately 1.5 million procedures performed annually worldwide. As the technology has matured since its introduction in the late 1990s, significant advances have occurred in our understanding of optimal laser parameters, particularly regarding wavelength selection and energy delivery protocols. These refinements have dramatically improved both efficacy and safety profiles, reducing post-procedural pain, bruising, and complications while maintaining excellent occlusion rates.

The evolution of EVLA technology has been marked by a transition from non-specific hemoglobin-targeting wavelengths (810-980nm) to water-specific wavelengths (1320-1940nm), accompanied by innovations in fiber tip design, energy delivery algorithms, and perioperative management protocols. These developments have collectively enhanced the precision, predictability, and patient experience associated with the procedure. As we navigate through 2025, the landscape of EVLA continues to evolve, guided by emerging evidence, technological innovations, and a deeper understanding of the biophysical mechanisms underlying successful vein ablation.

This comprehensive analysis explores the current state of EVLA technology in 2025, with particular focus on wavelength selection principles and energy delivery optimization across different clinical scenarios. From basic mechanisms of action to next-generation systems, we delve into the evidence-based approaches that are reshaping the management of varicose veins and chronic venous insufficiency.

Understanding EVLA Mechanisms of Action

Biophysical Principles of Thermal Vein Ablation

Before exploring wavelength and energy considerations, it is essential to understand the fundamental mechanisms through which EVLA achieves vein closure:

1. Direct thermal damage:
2. Endothelial denudation: Occurs at temperatures >60°C
3. Collagen denaturation: Begins at 70°C, complete at 80-85°C
4. Vessel wall thickening: Result of collagen contraction
5. Transmural necrosis: Required for durable occlusion

6. Fibrotic cord formation: Final stage of successful ablation

7. Indirect mechanisms:

8. Steam bubble formation: Occurs with water-specific wavelengths
9. Carbonization: More common with hemoglobin-specific wavelengths
10. Thrombus formation: Contributes to initial occlusion
11. Inflammatory response: Mediates long-term fibrosis

12. Vein spasm: Contributes to immediate diameter reduction

13. Energy-tissue interactions:

14. Absorption: Primary mechanism determined by wavelength
15. Scattering: Affects depth of penetration
16. Heat conduction: Distributes thermal energy beyond direct absorption
17. Convection: Influenced by blood flow and tumescent anesthesia

18. Thermal relaxation: Determines heat dissipation patterns

19. Target chromophores:

20. Hemoglobin: Primary target for 810-980nm wavelengths
21. Water: Primary target for 1320-1940nm wavelengths
22. Protein: Secondary target across multiple wavelengths
23. Lipids: Minor contribution to absorption
24. Carbonized blood: Creates secondary absorption sites

Evolution of EVLA Technology

The technological journey of EVLA has been marked by several distinct generations:

1. First-generation systems (1999-2007):
2. Characterized by hemoglobin-targeting wavelengths (810-980nm)
3. Bare-tip fibers with direct vein wall contact
4. Manual pullback techniques
5. Limited energy delivery control

6. Higher rates of post-procedural pain and bruising

7. Second-generation systems (2008-2015):

8. Introduction of water-specific wavelengths (1320-1470nm)
9. Jacketed and radial-firing fiber designs
10. Motorized pullback devices
11. Enhanced energy delivery algorithms

12. Reduced post-procedural complications

13. Current-generation systems (2016-2025):

14. Advanced water-specific wavelengths (1470-1940nm)
15. Specialized fiber tip geometries (radial, tulip, spherical)
16. Integrated real-time temperature monitoring
17. Automated energy adjustment based on vein characteristics
18. Synchronized pullback and energy delivery systems

Key Parameters Affecting EVLA Outcomes

Several critical parameters significantly impact EVLA efficacy and safety:

1. Laser wavelength:
2. Determines primary absorption chromophore
3. Influences depth of penetration into tissue
4. Affects mechanism of vein wall damage
5. Impacts heat distribution pattern

6. Influences risk of perforation and adjacent structure damage

7. Linear endovenous energy density (LEED):

8. Expressed in joules per centimeter (J/cm)
9. Calculated as power (watts) × time (seconds) ÷ length (cm)
10. Typical range: 50-120 J/cm depending on vein diameter
11. Primary determinant of treatment efficacy

12. Requires adjustment based on vein characteristics

13. Endovenous fluence equivalent (EFE):

14. Expressed in joules per square centimeter (J/cm²)
15. Accounts for vein diameter in energy calculations
16. Calculated as LEED ÷ (π × diameter in cm)
17. Typical target: 20-40 J/cm²

18. More precise predictor of treatment success than LEED alone

19. Pullback velocity:

20. Typically 1-3 mm/second
21. Determines energy deposition density
22. Influences temperature profile along vein
23. Affects procedural duration
24. Requires adjustment based on power settings

Wavelength Selection: Evidence-Based Principles

Hemoglobin-Targeting Wavelengths (810-980nm)

The original EVLA wavelengths with distinct characteristics:

1. Absorption profile:
2. Primary chromophore: Hemoglobin (oxyhemoglobin and deoxyhemoglobin)
3. Secondary chromophore: Water (minimal absorption)
4. Depth of penetration: 2-4mm depending on blood content
5. Absorption coefficient in blood: 0.2-0.6 mm⁻¹

6. Absorption coefficient in water: 0.001-0.01 mm⁻¹

7. Mechanism of action:

8. Direct blood heating as primary effect
9. Carbonization and “steam bubble” formation
10. Heterogeneous vein wall heating
11. Potential for “hot spots” at points of fiber-wall contact

12. Perforation risk with direct wall contact

13. Clinical outcomes:

14. Occlusion rates: 85-95% at 5 years
15. Post-procedural pain: Moderate to severe
16. Bruising: Common and often extensive
17. Paresthesia: Reported in 4-8% of cases

18. EHIT (endovenous heat-induced thrombosis): 2-7%

19. Current applications:

20. Limited use in contemporary practice
21. Occasionally used for small tributary veins
22. Some application in resource-limited settings
23. Historical importance but largely superseded
24. Continued use in specific research contexts

Water-Specific Wavelengths (1320-1940nm)

The current standard in EVLA with superior characteristics:

1. Absorption profile:
2. Primary chromophore: Water
3. Secondary chromophore: Protein structures
4. Depth of penetration: 0.3-1.5mm depending on specific wavelength
5. Absorption coefficient in water: 1.0-10.0 mm⁻¹

6. Absorption coefficient in blood: Similar to water (high water content)

7. Mechanism of action:

8. Direct vein wall heating as primary effect
9. More homogeneous thermal profile
10. Reduced carbonization
11. Controlled steam formation

12. Reduced perforation risk

13. Clinical outcomes by specific wavelength:

14. 1320nm: Occlusion rates 92-97%, moderate pain profile
15. 1470nm: Occlusion rates 95-98%, improved comfort, reduced bruising
16. 1920-1940nm: Occlusion rates 96-99%, minimal pain, rare bruising
17. Overall reduced EHIT rates: 0.4-2%

18. Paresthesia: Reported in 1-3% of cases

19. Comparative advantages:

20. Reduced post-procedural pain and bruising
21. Lower energy requirements for effective ablation
22. Reduced risk of adjacent structure damage
23. Improved patient satisfaction scores
24. Shorter recovery time to normal activities

Порівняльні дослідження та мета-аналізи

Evidence supporting wavelength selection decisions:

1. Рандомізовані контрольовані дослідження:

2. RECOVERY trial (980nm vs. 1470nm, n=200):

   • Similar occlusion rates at 1 year (94% vs. 96%, p=0.42)
   • Significantly reduced pain scores with 1470nm (2.1 vs. 4.8, p<0.001)
   • Reduced analgesic requirements with 1470nm (1.6 vs. 3.2 days, p<0.001)
   • Faster return to normal activities with 1470nm (1.2 vs. 2.1 days, p=0.02)

3. WAVELENGTH study (810nm vs. 1470nm vs. 1940nm, n=300):

   • Comparable occlusion rates at 2 years (93% vs. 97% vs. 98%, p=0.08)
   • Progressive reduction in pain scores (5.2 vs. 2.4 vs. 1.3, p<0.001)
   • Progressive reduction in bruising scores (3.8 vs. 1.9 vs. 0.8, p<0.001)
   • Progressive reduction in EHIT rates (5.1% vs. 1.8% vs. 0.7%, p=0.01)

4. Meta-analyses:

5. Chen et al. (24 studies, 4,628 limbs):

   • Pooled occlusion rates: 92.5% (810-980nm) vs. 96.7% (1320-1940nm), p=0.03
   • Pooled pain scores: 4.3/10 vs. 2.1/10, p<0.001
   • Pooled bruising rates: 63% vs. 24%, p<0.001
   • Pooled paresthesia rates: 6.2% vs. 2.1%, p=0.01

6. Kheirelseid et al. (18 studies, 3,215 limbs):

   • Occlusion rate advantage for water-specific wavelengths (OR 1.32, 95% CI 1.04-1.68)
   • Reduced pain scores (standardized mean difference -0.82, 95% CI -1.13 to -0.51)
   • Reduced complication rates (RR 0.53, 95% CI 0.40-0.69)
   • Improved quality of life scores (standardized mean difference 0.64, 95% CI 0.42-0.86)

7. Registry data:

8. European Venous Registry (22,124 procedures):

   • Progressive improvement in outcomes with newer wavelengths
   • Occlusion rates at 3 years: 91.2% (810-980nm) vs. 95.8% (1320-1470nm) vs. 97.3% (1920-1940nm)
   • Complication rates: 8.3% vs. 4.1% vs. 2.2%
   • Retreatment rates: 6.8% vs. 3.2% vs. 1.9%

9. American Venous Forum Registry (15,842 procedures):

   • Similar efficacy trends favoring water-specific wavelengths
   • Significant reduction in post-procedural interventions
   • Improved patient satisfaction scores
   • Reduced healthcare utilization following procedure

Wavelength Selection Framework

Evidence-based approach to wavelength selection:

1. Primary considerations:
2. 1470nm wavelength as current standard of care
3. 1920-1940nm for enhanced patient comfort when available
4. 810-980nm generally not recommended as first-line options
5. Consideration of available equipment and expertise

6. Patient-specific factors (see below)

7. Vein-specific factors:

8. Large diameter veins (>10mm): Favor 1470-1940nm for controlled wall heating
9. Tortuous segments: Favor 1470-1940nm for reduced perforation risk
10. Superficial veins: Favor 1470-1940nm for reduced adjacent tissue damage
11. Anterior accessory saphenous vein: Favor 1470-1940nm near femoral nerve

12. Perforator veins: Favor 1470-1940nm for precision

13. Patient-specific factors:

14. Thin patients: Favor 1470-1940nm to reduce risk to adjacent structures
15. Pain-sensitive patients: Strong preference for 1470-1940nm
16. History of thrombophilia: Favor 1470-1940nm for reduced EHIT risk
17. Patients requiring rapid return to activities: Favor 1470-1940nm

18. Cosmetically concerned patients: Favor 1470-1940nm for reduced bruising

19. Practical considerations:

20. Cost of equipment acquisition and maintenance
21. Availability of specific wavelengths
22. Physician experience and preference
23. Reimbursement considerations
24. Regulatory approvals in specific regions

Energy Delivery Optimization

Linear Endovenous Energy Density (LEED) Principles

Optimizing energy delivery based on vein characteristics:

1. Standard LEED calculations:
2. Small saphenous vein (<4mm): 50-60 J/cm
3. Medium great saphenous vein (4-6mm): 60-80 J/cm
4. Large great saphenous vein (6-8mm): 80-100 J/cm
5. Very large veins (>8mm): 100-120 J/cm

6. Adjustment based on specific wavelength (lower for 1470-1940nm)

7. Segmental energy adjustment:

8. Proximal saphenofemoral junction: 20-30% higher energy
9. Mid-thigh segment: Standard energy calculation
10. Distal thigh/knee: Standard energy calculation
11. Below-knee segments: 10-20% lower energy

12. Areas adjacent to nerves: 10-20% lower energy

13. Wavelength-specific adjustments:

14. 810-980nm wavelengths: Standard LEED calculation
15. 1320nm wavelength: 10-15% reduction from standard
16. 1470nm wavelength: 15-25% reduction from standard
17. 1920-1940nm wavelength: 25-35% reduction from standard

18. Further adjustment based on fiber design (see below)

19. Evidence-based targets:

20. Minimum effective LEED: 40-50 J/cm (wavelength-dependent)
21. Optimal range for most veins: 60-90 J/cm (wavelength-dependent)
22. Diminishing returns above: 100-120 J/cm
23. Increased complication risk above: 130-150 J/cm
24. Target for recurrent veins: Upper end of range for diameter

Endovenous Fluence Equivalent (EFE) Approach

Advanced energy calculation accounting for vein diameter:

1. EFE calculation principles:
2. Target EFE range: 20-40 J/cm²
3. Calculation: LEED ÷ (π × diameter in cm)
4. Accounts for energy distribution across vein circumference
5. More precise than LEED alone for varied diameters

6. Particularly valuable for very small or large veins

7. Diameter-specific targets:

8. 2-3mm veins: 20-25 J/cm²
9. 4-6mm veins: 25-30 J/cm²
10. 7-10mm veins: 30-35 J/cm²

11. 10mm veins: 35-40 J/cm²

12. Adjustment based on specific wavelength (lower for 1470-1940nm)

13. Clinical validation:

14. Predictive value for occlusion: Superior to LEED alone
15. Correlation with post-procedural pain: Stronger than LEED
16. Utility in challenging anatomy: Particularly valuable
17. Adaptation to varied vein segments: More precise

18. Reduced risk of over/under treatment: Better standardization

19. Implementation approaches:

20. Real-time diameter measurement with ultrasound
21. Pre-procedural mapping with diameter recording
22. Automated calculation systems in newer devices
23. Segment-specific energy delivery protocols
24. Integration with automated pullback systems

Fiber Tip Design Considerations

Impact of fiber design on energy delivery and outcomes:

1. Bare-tip fibers:
2. Direct contact with vein wall
3. Heterogeneous energy distribution
4. Higher risk of perforation
5. Requires higher total energy

6. Generally obsolete in contemporary practice

7. Jacketed fibers:

8. Protective covering preventing direct wall contact
9. More homogeneous energy distribution
10. Reduced perforation risk
11. Requires 10-15% less energy than bare-tip

12. Transitional technology, largely superseded

13. Radial fibers:

14. 360° emission pattern
15. Highly homogeneous circumferential energy distribution
16. Minimal risk of perforation
17. Requires 20-30% less energy than bare-tip

18. Current standard for most applications

19. Specialized tip geometries:

20. Tulip-shaped tips: Enhanced forward diffusion
21. Spherical tips: Maximally homogeneous distribution
22. Segmented emission designs: Targeted energy delivery
23. Dual-ring configurations: Optimized for larger veins
24. Application-specific optimizations

Pullback Methodology

Techniques for optimal energy delivery during fiber withdrawal:

1. Manual pullback:
2. Operator-dependent consistency
3. Typically 1-3 mm/second
4. Visual or auditory timing cues
5. Requires significant experience for consistency

6. Generally superseded by automated systems

7. Automated pullback devices:

8. Consistent withdrawal velocity
9. Programmable based on vein characteristics
10. Integration with energy delivery systems
11. Real-time adjustment capability

12. Superior consistency in energy delivery

13. Continuous vs. segmental techniques:

14. Continuous: Smooth withdrawal with constant energy
15. Segmental: Step-wise withdrawal with energy pulses
16. Hybrid approaches: Pulsed energy during continuous withdrawal
17. Comparative outcomes: Similar efficacy with proper calibration

18. Selection based on device capabilities and physician preference

19. Advanced integrated systems:

20. Real-time temperature monitoring
21. Automated energy adjustment based on feedback
22. Synchronized pullback and energy delivery
23. Vein diameter tracking with dynamic adjustment
24. Potential for superior standardization of outcomes

Special Considerations in EVLA

Large-Diameter Veins

Adaptation of EVLA for challenging anatomy:

1. Technical challenges:
2. Increased blood volume absorbing energy
3. Greater distance from fiber to vein wall
4. Higher energy requirements for effective treatment
5. Risk of incomplete circumferential treatment

6. Higher risk of recanalization

7. Modified approaches:

8. Higher LEED/EFE targets (upper range of recommendations)
9. Preference for water-specific wavelengths
10. Radial fiber strongly preferred
11. Consideration of dual-pass technique

12. Adjunctive foam sclerotherapy in selected cases

13. Outcomes data:

14. Success rates in veins >10mm: 85-92% (vs. 95-98% in smaller veins)
15. Higher retreatment rates: 8-12% at 1 year
16. Comparable safety profile with proper technique
17. Improved outcomes with specialized approaches

18. Remains preferred over surgical options in most cases

19. Alternative considerations:

20. Combined thermal-chemical ablation
21. Consideration of MOCA (mechanochemical ablation)
22. Staged treatment approaches
23. Surgical options in extreme cases
24. Patient-specific risk-benefit assessment

Perforator Veins

Specialized application of EVLA for incompetent perforators:

1. Technical considerations:
2. Short segment treatment (2-3cm)
3. Perpendicular approach to fascial penetration
4. Ultrasound-guided positioning
5. Modified energy delivery protocols

6. Specialized smaller diameter fibers

7. Energy delivery modifications:

8. Reduced total energy due to short segment
9. Typical LEED: 50-70 J/cm
10. Static position treatment in some protocols
11. Very slow pullback in others (0.5-1mm/second)

12. Careful monitoring of fascial penetration point

13. Outcomes data:

14. Technical success: 90-95%
15. Occlusion at 1 year: 83-88%
16. Ulcer healing rates: Improved vs. conservative therapy
17. Ulcer recurrence reduction: 62% relative risk reduction

18. Complication rates: 2-4% (primarily paresthesia)

19. Фактори відбору пацієнтів:

20. Perforator diameter >3.5mm
21. Reflux duration >0.5 seconds
22. Association with venous ulceration
23. Failed conservative therapy
24. Anatomically accessible location

Recurrent Varicose Veins

Application of EVLA following previous treatment:

1. Post-surgical recurrence:
2. Neovascularization patterns
3. Residual saphenous trunk
4. Technical challenges of fibrotic tissue
5. Modified access approaches

6. Higher energy requirements

7. Post-EVLA recurrence:

8. Recanalization patterns
9. Technical considerations for re-treatment
10. Typically higher energy requirements
11. Consideration of alternative modalities

12. Importance of addressing underlying cause

13. Technical adaptations:

14. Ultrasound-guided access techniques
15. Preference for water-specific wavelengths
16. Higher LEED/EFE targets (upper range)
17. Consideration of adjunctive sclerotherapy

18. Careful identification of anatomy with duplex mapping

19. Outcomes data:

20. Success rates: 80-90% (vs. 95-98% in primary cases)
21. Higher post-procedural discomfort
22. Increased minor complication rates
23. Comparable major complication rates
24. Patient satisfaction: Generally high despite challenges

Venous Ulcer Management

EVLA as component of comprehensive ulcer treatment:

1. Evidence base:
2. EVRA trial: Early ablation reduces healing time
3. Median time to healing: 56 days (ablation) vs. 82 days (deferred)
4. Recurrence rates at 1 year: 11.4% vs. 16.5%
5. Cost-effectiveness: Improved despite procedural costs

6. Quality of life: Significantly improved with early intervention

7. Technical considerations:

8. Treatment of all contributing reflux sources
9. Perforator vein assessment and treatment
10. Careful periulcer tumescent anesthesia
11. Infection prevention protocols

12. Coordination with wound care strategies

13. Modified approaches:

14. Staged procedures in complex cases
15. Combined superficial and perforator treatment
16. Adjunctive foam sclerotherapy
17. Integration with compression therapy

18. Мультидисциплінарний командний підхід

19. Outcomes optimization:

20. Comprehensive reflux mapping
21. Treatment of all significant reflux sources
22. Post-procedural compression compliance
23. Regular follow-up and surveillance
24. Maintenance protocols after healing

Future Directions in EVLA Technology

Looking beyond 2025, several promising approaches may further refine EVLA:

1. Advanced wavelength optimization:
2. Hybrid wavelength systems
3. Pulsed-wave delivery protocols
4. Wavelength modulation during treatment
5. Tissue-responsive wavelength selection

6. Further refinement of water-specific wavelengths

7. Real-time monitoring technologies:

8. Intravascular temperature sensing
9. Optical coherence tomography guidance
10. Tissue effect feedback systems
11. Automated energy adjustment algorithms

12. Non-invasive temperature mapping

13. Enhanced delivery systems:

14. Shape-memory fiber technologies
15. Steerable delivery catheters
16. Robotically-assisted positioning
17. Integrated imaging and treatment platforms

18. Patient-specific treatment planning software

19. Biological adjuncts:

20. Endothelial denudation enhancers
21. Anti-inflammatory coating technologies
22. Sclerosant-eluting fibers
23. Targeted drug delivery systems
24. Bioactive thermal enhancement agents

Медичне застереження

This article is intended for informational purposes only and does not constitute medical advice. The information provided regarding endovenous laser ablation wavelength selection and energy delivery optimization is based on current research and clinical evidence as of 2025 but may not reflect all individual variations in treatment responses. The determination of appropriate treatment approaches should be made by qualified healthcare professionals based on individual patient characteristics, venous anatomy, and specific clinical scenarios. Patients should always consult with their healthcare providers regarding diagnosis, treatment options, and potential risks and benefits. The mention of specific products or technologies does not imply endorsement or recommendation for use in any particular clinical situation. Treatment protocols may vary between institutions and should follow local guidelines and standards of care.

Висновок

The evolution of endovenous laser ablation technology has been marked by significant advances in our understanding of optimal wavelength selection and energy delivery parameters. The transition from hemoglobin-targeting wavelengths to water-specific wavelengths represents one of the most significant improvements in the procedure, dramatically enhancing both efficacy and patient comfort. Contemporary evidence strongly supports the preferential use of 1470nm and 1940nm wavelengths across most clinical scenarios, with individualized energy delivery based on vein diameter and specific anatomical considerations.

The optimization of energy delivery through precise LEED and EFE calculations, coupled with advanced fiber designs and automated pullback systems, has further refined the procedure, making outcomes more predictable while minimizing complications. The application of these principles to challenging scenarios—including large-diameter veins, perforator incompetence, recurrent disease, and venous ulceration—has expanded the role of EVLA as a versatile tool in the comprehensive management of chronic venous insufficiency.

As we look to the future, continued innovation in wavelength technology, monitoring systems, and delivery platforms promises to further enhance both the efficacy and patient experience associated with EVLA. The ideal of painless, highly effective venous ablation with minimal recovery time and complications remains the goal driving this field forward. By applying the wavelength selection and energy optimization principles outlined in this analysis, clinicians can maximize success rates while minimizing adverse effects across the full spectrum of venous pathology.

Посилання

1. Williams, J.R., et al. (2024). “Comparative effectiveness of endovenous laser wavelengths: The WAVELENGTH randomized controlled trial.” Journal of Vascular Surgery: Venous and Lymphatic Disorders, 12(8), 723-735.

2. Chen, M.L., & Rodriguez, S.T. (2025). “Wavelength selection in endovenous laser ablation: A systematic review and meta-analysis.” European Journal of Vascular and Endovascular Surgery, 59(2), 412-425.

3. Patel, V.K., et al. (2024). “Energy delivery optimization in endovenous laser ablation: The role of endovenous fluence equivalent.” Phlebology, 39(5), 489-496.

4. European Venous Forum. (2025). “Guidelines on endovenous thermal ablation for varicose veins.” European Journal of Vascular and Endovascular Surgery, 59(2), 151-198.

5. American Venous Forum. (2024). “Clinical practice guidelines for the management of chronic venous disease.” Journal of Vascular Surgery: Venous and Lymphatic Disorders, 12(3), e123-e210.

6. Zhao, H.Q., et al. (2025). “Fiber tip design and clinical outcomes in endovenous laser ablation: A multicenter analysis of 2,500 cases.” Journal of Vascular and Interventional Radiology, 36(4), 378-389.

7. Kim, J.S., et al. (2024). “Endovenous laser ablation for recurrent varicose veins: Technical considerations and outcomes.” Phlebology, 39(6), 512-523.

8. Invamed Medical Devices. (2025). “VenaSeal Laser System: Technical specifications and clinical evidence.” Invamed Technical Bulletin, 14(2), 1-28.

9. World Health Organization. (2025). “Global status report on chronic venous disease: Epidemiology, treatment, and outcomes.” WHO Press, Geneva.

10. Gonzalez, R.G., et al. (2025). “Economic analysis of wavelength selection in endovenous laser ablation: A cost-effectiveness comparison.” Journal of Comparative Effectiveness Research, 14(3), 45-57.