Endovenous Laser Ablation of Varicose Veins after Direct Percutaneous Puncture

Abstract

BACKGROUND Although endovenous laser ablation has been demonstrated to effectively occlude incompetent saphenous veins, it does not treat branch varicosities directly. OBJECTIVE The objective was to evaluate the technical feasibility and early results of the direct ablation of branch varicosities using a 980-nm diode laser. MATERIALS AND METHODS From July to August 2005, 17 patients (21 limbs; male:female ratio, 7:10; mean age, 50.1 years; range, 24–62 years) with varicose veins were enrolled in this study. Endovenous laser ablation was performed in incompetent saphenous veins. Thereafter, branch varicosities were percutaneously punctured and a direct laser ablation was performed using a 400-μm laser fiber. Patients were evaluated at 1 week and at 1-, 3-, and 6-month intervals. RESULTS Technical success in branch varicosities was achieved in 11 of 15 limbs (71.4%). Continued closure of treated saphenous veins was evident in 11 of 11 limbs (100%) at 1-month follow-up. Successful ablation in varicose tributaries was seen in 6 of 11 limbs (54.5%) at 1-month follow-up and ablation failed in 5 limbs. One of the 11 limbs (9%) had a skin burn that required treatment. CONCLUSION Despite partly successful occlusion, we suggest that direct laser ablation cannot replace classic methods of treating branch varicosities, because of its high failure rate and the risk of skin burns.