Endovenous laser therapy of varicose veins – 13-year Czech experience

Abstract

Aims In last more than 15 years, mini-invasive endovascular therapy of varicose veins have been introduced into clinical practice – one of the first was endovenous laser ablation (EVLA) of venous trunks. Thermal damage of the patological venous wall leads to contraction and obliteration of the vein and, gradually, to its full resorption. This review describes our own laboratory and clinical experience with these procedures. Material and methods After meticulous laboratory experiments starting in 2002 we performed in total more than 1700 endovenous laser procedures of trunk varicose veins of lower extremities using different lasers in more than 1300 patients (great, small and accessory saphenous and Giacomini veins). Every patient was preoperatively examined clinically and with color duplex machine. Postoperative follow-up (clinical and duplex ultrasound) was performed after 3–5 days and 1 month, 6 months and yearly thereafter. The results were evaluated by comparison of CEAP clinical class and quality of life (QoL) pre- and postoperatively and by the percentage of recanalizations and also using Kaplan-Meier life-table method. Results Two cases of peripheral thrombosis but no pulmonary embolism were diagnosed in the postoperative period; from the whole cohort, the postoperative data were available during different time periods in 99% of cases. Saphenous occlusion was verified in 97.3% after 1 month, non-occlusion or early reopening was seen in 2.7%. Final occlusion rate was 94%. Kaplan-Meier analysis showed nearly 89% occlusion rate. Mean clinical CEAP classification improved from 2.22 (before operation) to 0.24 (1 month after) and 0.48 (last visit) and also QoL was significantly better in laser group compared to traditional surgery group (P Conclusions Apart from minimizing recurrence, EVLA is also valuable with respect to its cosmetic effect and gentleness of the procedure, allowing fast return to full activity. The results of the procedure depend mainly on meticulous preoperative ultrasound examination and technically excellent procedure to administer sufficient amount of energy to the venous wall. The long-term results of these procedures are equal or even better than traditional open surgery.