The relative roles of power, linear endovenous energy density, and pullback velocity in determining short-term success after endovenous laser ablation of the truncal saphenous veins

Abstract

ObjectiveThe objective of this study was to describe the relative contributions of power output, linear endovenous energy density (LEED), and pullback rate (PBR) in determining successful long-term occlusion of the truncal saphenous veins after endovenous laser ablation (EVLA). MethodsA consecutive 203 patients (336 ablated veins) with reflux of the great saphenous vein or small saphenous vein (Clinical, Etiology, Anatomy, and Pathophysiology class C2-C6) defined by duplex ultrasound and clinical criteria were treated with 1470-nm EVLA at a power of 6 to 12 W. Prospective outcomes were evaluated in serial clinical and duplex ultrasound follow-up. Univariate logistic regression (ULR) and multivariable logistic regression modeling assessed LEED, power output, and PBR as success predictors and optimal settings for sustained closure. ResultsHigher power outputs (8-12 W) were significantly better than lower outputs (6-7 W) for successful closure. ULR suggested a ≥90% probability of success for power output >10.34 W (P < .001) and LEED >26.56 J/cm (P = .001). Power output was foremost (P < .001) and LEED second (P < .001), and PBR was insignificant overall (P = .38), becoming significant only at LEED values >26 J/cm (P < .001). Multivariable logistic regression confirmed both power (P < .040) and LEED (P < .008) but not PBR (P = .69) as significant determinants. Clinical side effects were not associated by ULR with power output (P = .14), LEED (P = .71), or PBR (P = .39). ConclusionsPower and LEED are separate but important determinants of short-term EVLA success. Threshold-dependent effects are observed for PBR (LEED ≤26 J/cm or ≥26 J/cm), with significant PBR correlation seen only at higher LEED values. Whereas ideal values for power and LEED differ according to the clinical scenario, our findings suggest that use of higher power outputs and greater LEED values (≥90% success probability achieved with power >10.34 W or LEED >26.56 J/cm) may yield optimal results.