Comparing the Effects of Radial and Jacketed Laser Tip Fibers on Outcome of Endovenous Laser Ablation of Lower Limb Truncal Venous Reflux

Abstract

Saphenous vein reflux is one of the leading causes of cosmetic and functional disabilities.The recent ESVS guidelines recommend endovenous thermal ablation over surgery or sclerotherapy for the treatment of great saphenous vein (GSV) reflux in patients with chronic venous disease.The aim of this study is to compare different laser fiber tip configurations to outcome regarding technical success and incidence of complications. A retrospective analysis conducted on patients with documented GSV reflux from 2020 to 2022, comparing baseline parameters and outcome between 2 groups of laser tip fibers used; radial tip and jacketed tip. Primary end point was technical success. Secondary endpoints included incidence of complications in each group, and VCSS score difference in both groups. Inclusion criteria entailed patients with primary varicose veins over the age of 18 years, free from malignancy, hematological disorders, and having documented GSV reflux of more than 0.5 seconds. All patients had endovenous laser ablation (EVLA) of the, with complementary foam sclerotherapy or ambulatory phlebectomies as required. A total of 74 patients underwent EVLA (85 limbs). 54 were done using the radial laser fibers, and 32 using jacketed fibers. Technical success was achieved in 78 limbs (92.9%), 6 limbs (7.1%) had recanalization of the proximal 3cm GSV at 1 month, 2 patients experienced hematomas, and 5 patients had superficial vein thrombosis.There was no significant association between postoperative pain, bruising, recanalization, hematoma, and superficial vein thrombosis, with different laser fiber tip configurations (p-value .95, .6, .18, 1, & 1 respectively), nor was there any significant difference in VCSS between them (p-value .14).Technical success was 90% in the jacketed fibers and 94.1% in the radial fibers group (p-value 0.18). Neither does laser fiber tip configuration nor its make have a significance on outcome of EVLA of GSV reflux. Both radial and jacketed laser fiber tips exhibit similar safety and efficacy in EVLA.