Endovenous Laser Ablation of Great Saphenous Veins Performed Using Tumescent Cold Saline Solution without Local Anesthesia

Abstract

In recent years, laser systems with higher wavelengths, associated with new optical fibers, have shown excellent short-term results in treating saphenous veins and reducing the side effects and, in particular, the postoperative pain. However, if the patients are not anesthetized, they may feel pain even when using low energy with the high-wavelength laser; the only tumescent local anesthesia often does not guarantee a complete pain control during endovenous laser ablation (EVLA). Aim of this study was to demonstrate that the local anesthesia during EVLA of great saphenous veins (GSVs) is not essential for the perioperative comfort of the patient if a mild sedation is made. Forty-nine incompetent GSVs were treated by EVLA with a cold saline tumescent solution (CSTS) without local anesthetic drugs. EVLA was performed with a 1540-nm diode laser and a 600-μc ball-tipped fiber. Intraoperative ultrasonography was then used to guide delivery of CSTS (cold saline solution 0.9% at 5°C) using a motor pump under intravenous sedation. The gravity of chronic venous disease was determined according to the clinical-etiology-anatomy-pathophysiology classification. Patients rated surgery global pain according to 4 types: "extremely," "rather," "slightly," and "not at all" painful. Twenty-five cases (51%) were classified as C3, 20 (41%) as C2, 6 (13%) as C4, and 1 (2%) as C6. Midazolam 2.5 mg + a mean of 0.16 mg of fentanil (minimum: 0.10; maximum: 0.20; standard deviation [SD]: 0.4) + a mean of 178.21 mg of propofol (minimum: 100; maximum: 300; SD: 47.1) were administrated as intravenous sedation. The total average linear endovenous energy density was 57.7 J/cm. Approximately 250 mL (minimum: 100; maximum: 780) of CSTS was administered. No Patient has had pain during the procedure. All patients were discharged 2.5 hrs after surgery. EVLA under sedation using CSTS without diluted anesthetic drugs is a suitable technique in an outpatients clinic, especially useful if the ablation of the saphenous vein is combined with an extended phlebectomy or if a bilateral treatment is performed, to eliminate the risks of overdose with local anesthesia and with the aim of improving the comfort of the patient.