Effect of the wide-spread use of endovenous laser ablation on the treatment of varicose veins in Japan: a large-scale, single institute study.

Abstract

Background and aims: In Japan, stripping under general anesthesia, lumbar anesthesia and tumescent local anesthesia has been used in the treatment of primary varicose veins due to saphenous vein insufficiency. However endovenous laser ablation (EVLA) using a 980 nm diode laser has received National Health Insurance (NHI) coverage in 2011, while EVLA using a 1470 nm diode laser with a radial 2-ring fiber has received coverage in 2014. As a result, the use of EVLA has become widespread in Japan. We herein report on the results of varicose veins treatment at our hospital. Subjects and methods: Two hundred eighty-nine patients with saphenous vein reflux who received treatment between October 2013 and December 2015 were included in the present study. The surgical results (operating time, complications, ablation rate, linear endovenous energy density [LEED], and the incidence of surgical site infections [SSI]) were retrospectively assessed and compared among the patients who underwent stripping (group A) and those who underwent EVLA (group B) according to the Japan Guidelines for EVLA. Results: Group A and group B included 49 patients and 240 patients, respectively. Group B comprised 20 patients who underwent EVLA using a 980 nm laser (group B1) and 240 patients who underwent EVLA using a 1470 nm laser (group B2). The operative time in group A was 48 ± 16 minutes, whereas that in group B was 28 ± 10 minutes. The operative time, the length of the treated vein and LEED in groups B1 and B2 were 40 ± 11 and 27 ± 10 minutes, 36 ± 10 and 33 ± 10 cm and 84 ± 10 and 77 ± 18 J/cm2, respectively. Furthermore, the mean operative time in group B1 (with no phlebectomy) was 31 ± 9 minutes, whereas that in group B2 (with no phlebectomy) was 22 ±7 minutes, which was statistically significant (p<0.05). The level of pain peak was day 1 in group A patients and on days 3-7 in group B1 patients; the group B2 patients felt little pain. Surgical site infection at the phlebectomy site was observed in two group B2 patients. EVLA resulted in an occlusion rate of 99.6% at approximately two years after surgery. Conclusions: This study showed that EVLA using the 1470-nm laser caused less pain and bruising than EVLA using the 980-nm laser. The operative time of EVLA was approximately 9 minutes shorter than that of stripping. Therefore, EVLA using the 1470-nm laser might be the first treatment of choice for patients with saphenous vein reflux. However conventional surgery remains important because EVLA is not suitable in cases in which the diameter of the saphenous veins is >20 mm or in patients with highly tortuous veins.