The wattage should not be increased for a larger vein. As long as ther is good compression and apposition of the vein walls the laser should work for veins up to 20 mm in size.

Published on Jul 11, 2012

We typically use 12 watts for the Lesser (short) saphenous and 15 watts for the Greater saphenous.
We do not increase the watts for size of vein as sufficient tumescent will aid in decreasing the diameter of the vein.
Norman N. Bein MD FACS RVT

Published on Jul 11, 2012

There is a some evidence that the size of the vein effects long term
closure . The best way to scientifically make this adjustment is to not
just keep tract of the amount energy give per centimeter LEED , but also
the the amount energy delivered per centimeter of length and per surface
are of vein wall { which is determined by its diameter} .This
is calculation is called the endovenous fluence and should be used to give
the optimal energy to have successful treatment of the vein. At this years
annual congress of the American College of Phlebology I presented a paper
that looked at what average endevenous energy densities which were
not successful and which were successful at 2 year closure of saphenous
veins. It is clear that the amount of energy delivered to a vein should be
increased for a larger veins.

Published on Jul 11, 2012

Is this question from a provider?
The concept is called fluence and usually you do increase the time of laser exposure for the larger veins to deliver more joules to the area. So a slower pullback or a higher wattage can achieve this, but care must be taken with higher wattage not to overdo the energy which can lead to perforations of the vein.
Review/look up Dr. Tom Probstle papers on this topic from germany those should help or perhaps more hands on training might be needed.
I have treated veins greater that 1.5 cm though with appropriate fluence/joules.
Michael D. Ingegno, MD

Published on Jul 11, 2012

I would suggest more formal training. This blog is not the place to make
instructional recommendations.

Published on Jul 11, 2012

It is difficult to answer this question without knowing what type of laser is being used and what vein is being treated. For example, a 940 diode for a greater saphenous vein could use 15 watts while a 1470 diode would use 4 watts. The size of the vein on ultrasound is not the size of the vein at the time of treatment. Vein size can be reduced by tumescence, compression and Trendelenburg position.

Published on Jul 11, 2012