Combined Endovenous Laser Therapy and Ambulatory Phlebectomy: Refinement of a New Technique

Abstract

Sclerotherapy (IS) or ambulatory phlebectomy (AP) are required as subsequent interventions in majority of cases following endovenous laser therapy (EVLT). We assessed whether AP performed concomitantly with EVLT (EVLTAP), is effective, acceptable, and reduces subsequent requirement for interventions. 67 patients (70 limbs) with great saphenous varicosities underwent EVLTAP. Pain was assessed on days 1, 4 and 7 using a visual analogue scale (VAS) of 0 to 10. Clinical and ultrasound assessments were done at 1, 6 and 12 weeks (no ultrasound at 6 weeks). Residual varicosities underwent further AP or IS. Patients' satisfaction with the cosmetic outcome and overall treatment was assessed at 12 weeks using a VAS rating. 49 patients (70%) completed follow-up. Median pain scores were 1.6 (IQR 0.2-4.8), 0.3 (0-1.4) and 0.2 (0-1.1) on days 1, 4 and 7 respectively. Ultrasound demonstrated 69 (99%) and 47 (96%) occluded long saphenous veins at 1 and 12 weeks respectively. Subsequent IS or AP was performed on 3 (4%) or 1 (1%) limbs respectively. Cosmetic satisfaction was 9.6 (IQR 8.9-10) and overall satisfaction 9.8 (IQR 9.3-10). EVLTAP produces excellent results, is feasible and acceptable, and obviates need for subsequent procedures in the short-term.