Effect of treated length in endovenous laser ablation of great saphenous vein on early outcomes

Abstract

The aim of this preliminary study was to document the effect of treated great saphenous vein (GSV) length on short-term outcomes using freedom from secondary intervention as a marker. Analysis was performed of a prospective database of endovascular laser therapy (EVLT) procedures performed by a single surgeon in an NHS hospital setting using a standardized technique in a series of consecutive ambulatory patients. During a 2-year period, 131 episodes with sufficient data were recorded. The effect of GSV vein length treated was assessed at 6 weeks. Hospital records were monitored for unplanned events for a minimum of 6 months. All patients with primary or recurrent varicose veins affecting the GSV were offered EVLT ablation. Aneurysmal vein segments, severely tortuous veins, ankle-brachial pressure index of<0.5, and presence of thrombus in the vein were excluded. Patients on anticoagulation were not excluded. Of 192 patients scheduled for EVLT for varicose veins, 61 were excluded from the analysis (40 small saphenous veins, 5 failures to complete procedure, 16 with incomplete data). There were 79 women (60.3%) and 52 men (39.7%), with a mean age of 54± 16 (standard deviation) years. CEAP clinical categories were C2, 30 (22.9%); C3, 33 (25.2%); C4, 52 (39.7%); C5, 1 (0.8%); and C6, 15 (11.5%). In addition to EVLT, ultrasound-guided foam sclerotherapy or surgical avulsions were used when required. The main outcome measure was freedom from ancillary treatment with foam sclerotherapy or multiple avulsions. The freedom from reintervention was 68.9% if the treated vein length was 0 to 20 cm (n= 17), 86.5% for a vein length of 21 to 39 cm (n= 74), and 100% for a vein length >40 cm (n= 41; P= .003). The total length of vein treated appears to have a significant effect on reintervention rates. This may be due to better occlusion of tributaries. Where possible, ≥30 cm should be treated; otherwise, sclerotherapy or avulsions may be incorporated simultaneously to allow for one-stop treatment.