The Effect of Endovenous Laser Ablation of Incompetent Perforating Veins and the Great Saphenous Vein in Patients with Primary Venous Disease

Abstract

This study aimed to investigate the clinical results and fate of incompetent perforating veins (IPVs) following treatment of superficial venous insufficiency, with or without endovenous laser ablation (EVLA) of IPVs. A retrospective analysis of patients with primary venous insufficiency (PVI) was conducted in a single institution from January, 2010 to December, 2011. IPVs were found in 311 patients (376 limbs). Among these, 132 patients (156 limbs) were treated with EVLA of IPVs and varicose vein surgery, and the remaining 179 patients (220 limbs) were treated with varicose vein surgery alone and served as controls. The fate of the IPVs, complications and clinical results were evaluated. The technical success rate of EVLA of IPVs was 100%. There was no statistical difference in complications between the two groups. At 1 year follow up, 68 perforators were recanalized and still incompetent in the EVLA treated IPV group compared with 437 incompetent perforators in the untreated IPV group (18.7% vs 92.6%; P < .001). A faster median ulcer healing time (1.40 months) was found in the EVLA treated IPV group (95% confidence interval [CI] 1.15-1.66 vs 3.30 months [95% CI 2.50-4.10]; P = .001), even though no statistical difference in the 12 month ulcer healing rate was observed between the two groups (P = .584). There were no significant differences between the two groups for varicose vein recurrence rates or changes in the Venous Clinical Severity Score (VCSS). EVLA was safe and effective in reducing the number of IPVs in PVI. However, the addition of IPV EVLA had no effect on ulcer healing rate, VCSS or varicose vein recurrence at 1 year follow up.