A Comparative Study of the Efficacy of Endovenous Laser Treatment of the Incompetent Great Saphenous Under General Anesthesia with External Air Cooling with and Without Tumescent Anesthesia

Abstract

This clinical study reports our experience with endovenous laser treatment (ELT) in which external air cooling is used without classic tumescent anesthesia. Two hundred thirty-two patients underwent ELT under general sedation. In group A (n=192), ELT was performed with air cooling but without the concurrent use of tumescent anesthesia. In group B (n=40), patients were treated using the traditional tumescent technique. The parameters were similar for both groups: 980-nm diode laser, power of 15W, and pulse duration of 1second. The laser fiber and catheter were manually withdrawn in 3-mm increments. Ultrasound was performed to reevaluate vein closure at the end of surgery and 2 and 8weeks and 1year after. During follow-up, complications such as burns, dyschromia, pain, and dysesthesia, as well as time used for surgery were recorded. A 96% closure rate was obtained in groups A and B at 2 and 8 weeks. This rate remained stable 1 year after the ELT procedure. Except for a higher percentage of ecchymoses in group B (55%) than in group A (0%) (p<0.001), no significant differences were observed for complications. With external air cooling, ELT took 17.5minutes to perform for the whole leg, compared with 38.5minutes when using tumescent anesthesia (p<0.05). ELT surgery for the great saphenous vein can be safely performed using the air cooling method and is as efficacious as ELT done with tumescent anesthesia but takes significantly less time to perform.