Endovenous laser therapy with echosclerotherapy as a hybrid method for chronic venous insufficiency: experience in 200 patients and literature review.

Abstract

Surgical treatment of chronic venous insufficiency (CVI) includes sclerotherapy, cryosurgery, CHIVA method (from the French for ambulatory conservative hemodynamic treatment venous insufficiency), chemical and mechanical obliteration, or phlebectomy. A hybrid treatment that combines sclerotherapy with endovenous laser ablation (EVLA) at 980 nm or 1470 nm or Nd:YAG laser at 1064 nm is also increasingly used. This paper synthesizes the current knowledge of CVI of the lower limbs and demonstrates promising clinical practice experiences using a hybrid method that combines EVLA with intraoperative or postoperative ultrasound-guided foam sclerotherapy (UGFS), also known as echosclerotherapy. A group of 200 patients was enrolled in the study. All patients underwent a hybrid method of treatment combining EVLA and UGFS. Under tumescent anesthesia, venipuncture of the great saphenous vein (GSV) trunk was performed, followed by 1470 nm laser therapy (80-100J/10W). During the procedure, 2% polidocanol foam was injected into the insufficient collateral veins extending from the main trunk of the GSV. After surgery, compression therapy in the form of grade II compression stockings was used. All patients underwent a follow-up duplex Doppler ultrasound four weeks after the procedure. It was observed that 196 patients had complete obstruction of the femoral segment of the GSV, while four patients showed signs of minor recanalization of the femoral segment. After 12 months, 198 patients showed complete fibrosis, partial or complete absorption of the saphenous vein, and varicose lesions. Two patients underwent UGFS again after 12 months because of recurrent varicose lesions. At four weeks after UGFS, local pain of thrombosed varicose lesions was observed in 20% of patients. Hemosiderin staining was observed in 15% of patients, but this completely resolved within 6-12 months. In 1% of cases, symptoms of dyspnea and cough were reported, which resolved a few minutes after the procedure - approximately 1% of patients presented with symptoms of matting. There were no severe complications during the 12-month follow-up period. A high efficiency of 98% was observed (196/200 patients) at the 12-month follow-up after hybrid EVLA with UGFS treatment. Follow-up UGFS at four weeks after laser ablation showed 99% efficacy at the 12-month postoperative follow-up. Major complications after the hybrid method treatment combining EVLA with UGFS were not observed. Hybrid methods are more effective (98-99%) and give a lower chance of relapse.