Patency of Anterior Accessory Saphenous Vein Following Endovenous Laser Ablation for Varicose Veins: Bare-Tip Versus Radial Fiber

Abstract

Introduction - Anterior accessory saphenous vein (AASV) insufficiency is one of the most common causes of late recurrence after endovenous laser ablation (EVLA) for great saphenous vein (GSV) insufficiency1)2). Therefore, reduction of the AASV patency rate after EVLA can be associated with better long-term results. The aim of this study is to compare the patency rate of saphenofemoral junction tributaries after EVLA between bare-tip and radial fibers. Methods - We reviewed 375 limbs in 339 patients undergoing EVLA for GSV insufficiency. The bare-tip fiber with a 980-nm diode laser was used in 299 limbs (group B). The radial fiber with a 1470-nm diode laser was used in 76 limbs (group R). Concomitant ablation of AASV or high ligation of GSV was not included in this study. Patients who had previous EVLA, high ligation and stripping were excluded. Duplex ultrasound scanning was performed 3 months after EVLA to assess occlusion of the ablated GSV and patency of the saphenofemoral junction tributaries including the AASV, the posterior accessory saphenous vein (PASV) and the superficial epigastric vein (SEV) in both groups. Student-t tests and chi square tests were used to compare two groups. Results - The total occlusion rate of the ablated GSV at 3 months after EVLA was 100% in group R and 99% in group B, p = 0.999. The patent AASV was detected significantly (p = 0.004) less in group R (33 limbs, 43%) than in group B (184 limbs, 62%), whereas the PASV patency rate was similar (p = 0.815) in both groups (16% in group R, 15% in group B, p = 0.815). The SEV occlusion rate was 4% in group R and 1% in group B, p=0.101. There was no difference in age, gender, body mass index, CEAP classification and the proximal GSV diameter in both groups. Laser power was smaller in group R (8.9 +/- 0.9 W) than in group B (9.4 +/- 0.6 W), p < 0.001, however, linear endovenous energy density did not differ between the groups (79.9 +/- 13.6 J/cm in group R, 78.3 +/- 9.2 J/cm in group B, p = 0.198). The distance between the tip of the fiber and the common femoral vein was shorter in group R (9.7 +/- 2.4 mm) than in group B (17.5 +/- 4.9 mm), p < 0.001. Conclusion - EVLA using a radial fiber archived better occlusion rates of AASV. This result can be attributed to the position of the laser fiber tip closer to the saphenofemoral junction. Our study suggests that EVLA using a radial fiber will reduce the risk of late recurrence caused by AASV insufficiency in the treatment of GSV varicose veins. References1)J Vasc Surg. 2016; 63: 420-428.2)Eur J Vasc Endovasc Surg. 2011; 41: 685-690.