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original article

UGLA ‒ Ultrasound Guided Laser Ablation

A field report about a self-developed high-level

technique for EndoVenous Laser Ablation (EVLA)

DR PETAR DRAGIĆ,

Clinic “Dr Dragić”, Belgrade, Novi Sad and Banja Luka, Serbia

It has been almost two decades since the laser
started entering the world of varicose vein
surgery. Ever since the early days, when the
technology was still in the bud, we had to work
with something that was unknown, not un- UGLA is short for Ultrasound Guided Laser Ablation. It’s a
like exploring the unknown cosmos. We knew high-level technique that I use in my EVLA operations on
the anatomy, we knew what had to be done, a daily basis and that is a tool that helps me ensure that
but now the approach was no longer from the veins I operate on are definitely going to be permanent-
outside, external, but from the inside. Now we ly obliterated. If applied correctly, the ultrasound can not
had to adopt this new way of reasoning and only help guide the laser probe, but also help with moni-
thinking. toring ablation, improving vein-wall-to-probe contact, op-
timization and equivalent distribution of energy, avoiding
With the internal approach our eyes were no longer the probe carbonization and many other detrimental features.
ultimate tool, we needed a better insight. And this is Previously, it was thought that the amount of energy
where the ultrasound enters the stage. Thankfully, along delivered to the vein wall should be related to the dia-
with laser technology, ultrasound tech improved as well. meter of the vein seen while performing diagnostic ult-
And without it, I firmly believe, the EndoVenous Laser rasound examination, but this kind of application of the
Ablation (EVLA) would not be what it is today – a world laser has several downfalls. Firstly, it is not the lumen of
dominating method. the vein we are ablating, it is the wall, and the thickness
As with every novel and unexplored technology, we of the wall is often NOT in correlation with the diameter.
early adopters of EVLA, would often have discussions at > fig. 1
congresses, professional meetings and even privately, to
determine the best way to use the laser, but also the ul-
trasound. In the beginning, ultrasound was merely a tool
to guide the laser. This had proven to be a gross under-
statement to what the ultrasound means to laser surgery.
I decided from the beginning to dedicate myself fully
to this, at the time, future-like technology and have been Normal wall Thick wall Post-thrombotic wall © Dr. Petar Dragić
doing nothing but EVLA ever since. Due to this, I accu- fig.1 >Differences in vein wall thickness
mulated a vast wealth of experience and little-by-little
created protocols which now help me ensure that I pro-
vide every patient with the best possible outcome and Of course, to ensure successful ablation the entire thick-
guaranteed success. One of the protocols is dedicated to ness of the wall needs to be ablated. Thus, relying on dia-
the use of ultrasound during the process of ablation itself. meter rather than wall thickness will inevitably lead to
I have dubbed it UGLA. recanalization of ablated veins and unwanted results.

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