Endovenous Laser Ablation of Saphenous Veins Larger than 2 cm: a Prospective Study

Abstract

Background. The current catheters and fibres used for endovenous laser and radiofrequency ablation of varicose veins have a radial energy emission. This gives an opportunity to treat veins of a large diameter which was previously considered to be challenging. The majority of studies categorise veins of more than 1 cm in diameter as large (Chaar C.I., et al. 2011; Florescu C., et al. 2014). Many patients have saphenous veins 1–2 cm in diameter, which can be occluded in almost 100% of cases. Treating veins more than 2 cm in diameter with tumescent anaesthesia may be associated with formation of a “blind pocket”. This means that a part of the vein does not have appropriate contact with the fibre. This can be one of the reasons for recanalisation. The aim of this study was to investigate the results of endovenous laser ablation (EVLA) of saphenous veins larger than 2 cm in diameter. Methods. This was a prospective non-comparative study that included 231 patients who underwent 261 EVLA of the great saphenous vein (GSV) between November 2014 and June 2019. EVLA was performed using 1470 nm laser, radial fibres, and an automatic pull back device. All procedures were performed under tumescent anaesthesia. The average diameter of the veins at the saphenofemoral junction was 24 ± 6 mm (range 21–43 mm). EVLA was administered at the average power of 8–10 W. The linear endovenous energy density in dilated segments was 83–147 J/cm. The follow up period was 178 ± 67 days (range 61–540 days). Duplex ultrasound was performed on days one and seven, and months two and six after the treatment. Results. Two hundred and thirty (88%) veins were occluded the day after EVLA. In 31 (12%) cases there were non-occluded segments of dilated parts of the saphenous vein on the day after the procedure. These segments were found to be occluded in 21 of 31 patients at seven days. In 11 (4%) cases, ultrasound guided foam sclerotherapy (UGFS) was performed. Short stumps of GSV (19 ± 6 mm) were found in 12 (5%) patients at six month follow up, with no reflux in these stumps. Recanalisation of a long segment of the GSV with reflux was found in two (0.8%) cases, which was treated by EVLA and UGFS. Conclusion. EVLA using radial fibres is effective for a GSV more than 2 cm with a 99% occlusion rate in the early follow up period.