Efficacy Of Endovenous Laser Ablation Research Articles

A Systematic Review Network Meta-Analysis and Meta-Regression on Surgical and Endovenous Interventions for the Treatment of Lower Limb Venous Ulcer Disease.

Venous leg ulcer (VLU) disease constitutes the most severe form of chronic venous insufficiency. We performed a network meta-analysis and meta-regression to investigate the efficacy and safety of the various available interventions in the treatment of VLU. We conducted a systematic research corresponding to the instructions by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for studies reporting on surgical or endovenous interventions for the treatment of VLU. Following data extraction, we performed a Bayesian network meta-analysis and meta-regression. Primary endpoints included VLU healing and recurrence. The secondary endpoint was postintervention complications. Seventeen studies evaluating the impact of compression monotherapy, radiofrequency ablation (RFA), endovenous laser ablation (EVLA), sclerotherapy, and saphenous vein surgery on VLU treatment, consisting of 2156 patients (2186 VLU) were included. When compared to compression monotherapy, RFA was the only treatment displaying a statistically-significant impact on ulcer healing, odds ratio (OR) 5.80 (95% credibility interval (CI): 1.08-35.07), while EVLA, RR 0.06 (95% CI: 0.00-0.57), sclerotherapy, RR 0.07 (95% CI: 0.00-0.68) and RFA, RR 0.12 (95% CI: 0.01-0.91) were the 3 interventions reducing VLU recurrence. EVLA (SUCRA, 69.65) ranked as the most efficient intervention concerning ulcer recurrence reduction. Regarding postintervention complications, EVLA was the only intervention displaying a statistically-significant increased risk compared to compression monotherapy, RR 14.3 (95% CI: 2.03-172.56). Meta-regression analysis exploring the impact of perforator treatment on VLU failed to predict healing, β = -0.27 (95% CI: -2.55 to 1.85), recurrence, β = -0.02 (95% CI: -2.96 to 2.75) and complication outcomes, β = -0.089 (95% CI: -3.13 to 2.85). During sensitivity analysis, RFA and sclerotherapy failed to sustain their effects on ulcer healing and ulcer recurrence, respectively. In addition, sclerotherapy displayed statistically-significant inferior outcomes compared to both EVLA and RFA regarding ulcer recurrence. This is the first network meta-analysis examining the effect of various interventions on VLU disease. While we have demonstrated the efficacy of RFA and ELVA in ulcer recurrence prevention, our results regarding the impact of RFA and sclerotherapy on VLU healing and recurrence, respectively, should be interpreted with caution. In addition, this review raises questions concerning the value of surgery and perforator interventions in the treatment of VLU. Further research through randomized controlled trials is required. Our review has revealed the significant efficacy of endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in effectively reducing the incidence of ulcer recurrence when compared to compression monotherapy. These outcomes hold the potential to provide relevant insights to both medical practitioners and patients, thereby informing a more prudent and enlightened decision-making approach. Such informed decisions, aimed at mitigating the recurring occurrence of venous leg ulcers, carry profound significance given the considerable socioeconomic implications associated with this medical condition.

Efficacy of Endovascular Laser Ablation for the Management of Venous Leg Ulcers

Venous leg ulcers (VLUs) represent a significant disease burden worldwide owing to their high incidence, increasing prevalence, slow or nonhealing, high recurrence rate, and considerable patient and financial burden on the healthcare system. Newer, minimally invasive techniques have been widely used for the treatment of varicose veins with or without active VLUs. This is a retrospective study to evaluate the efficacy of endovenous laser ablation (EVLA) in the treatment of VLUs owing to superficial venous reflux.

Comparative analysis of endovenous laser ablation versus ultrasound-guided foam sclerotherapy for the treatment of venous leg ulcers.

Endovenous thermal and non‐thermal therapeutic approaches have become standard of care for the treatment of venous insufficiency. However, comparative studies on its use in the population of venous leg ulcer patients are scarce. The present study aimed at a comparison of the efficacy of endovenous laser ablation (EVLA) and ultrasound‐guided foam sclerotherapy (UGFS) for the treatment of venous leg ulcers (VUs). We retrospectively analyzed patient records of 68 patients with active VUs (C6 of the CEAP‐classification), who underwent EVLA (n = 33) or UGFS (n = 35) between January 2001 and January 2021. In 68 patients, 97 venous segments (GSV: 43, SSV: 17, NSV: 37) were treated. Ulcer surface area at initial presentation did not differ significantly between both treatment groups (EVLA: 7.7 ± 10.7 vs. UGFS: 8.5 ± 16.3 cm2; p = 0.73). No significant difference regarding patient characteristics was found, with the exception of age, as patients receiving UGFS treatment were significantly older (EVLA: 61 ± 17 vs. UGFS: 70 ± 14 years; p = 0.018). The rate of ulcer resolution was not significantly different between EVLA and UGFS groups (97.0% vs. 85.7%; p = 0.20). Also, the mean time to complete ulcer healing after endovenous intervention was comparable (EVLA: 59 ± 37 vs. UGFS: 63 ± 41 days; p = 0.68). However, the relapse rate was significantly higher for UGFS than for EVLA treated patients (31.4% vs. 3.0%; p = 0.002). Taken together, rates of ulcer resolution and ulcer healing time after endovenous intervention were comparable between both treatment modalities. Nevertheless, a significantly higher relapse rate was observed in UGFS treated patients.

Endovenous laser ablation: A comprehensive review.

To provide an evidence-based overview of endovenous laser ablation and describe its role as an effective and durable technique for the management of superficial venous insufficiency. The published literature on the treatment of varicose veins using endovenous laser ablation was reviewed. The literature search focused on the history of endovenous laser ablation, its safety and durability, known complications, and differences in outcomes based on the iterations of fiber type and laser wavelength. Treatment safety and efficacy of endovenous laser ablation appear to be based on the amount of energy administered over a defined distance, or the linear endovenous energy density. The ideal linear endovenous energy density varies with the laser wavelength and fiber-type. Post-operative pain and bruising may be reduced by the use of higher wavelength fibers or the use of radial or jacket-tip fibers as compared to bare-tip fibers. The incidence of endothermal heat-induced thrombosis remains low and has declined with increasing experience. Reports have demonstrated a greater than 90% technical success rate with saphenous endovenous laser ablation, long-term durability of ablation, and commensurate improvement in quality of life. Endovenous laser ablation is a safe and durable treatment option for the management of incompetent superficial and perforator veins of the lower extremities. As an endothermal technology, it remains a key component of the standard of care for the treatment of chronic venous insufficiency.

Possibilities of using the Colibri system for endovenous laser ablation

The purpose of the study was to assess efficacy of endovenous laser ablation of major saphenous veins by means of the Mediola single-ring radial light guides with the use of the 'Optical Handpiece MHP02 (Colibri)'. This non-comparative prospective study included 430 consecutive patients who underwent a total of 511 endovenous laser ablation procedures from January 2018 to March 2019. The great saphenous vein was subjected to obliteration in 343 (67.1%) cases, the anterior accessory saphenous vein - in 94 (18.4%) cases, and the small saphenous vein - in 74 (14.5%) cases. There were 170 (39.5%) men and 260 (60.5%) women, with a mean age of 52±12.8 years. The next day after the intervention the patients revisited the clinic for control examination, with the obtained findings demonstrating that occlusion of the target vein had been achieved in all 511 (100%) cases. At 2 months, we examined 411 (95.6%) people with a total of 484 (94.7%) treated veins. After 6 months, 399 (92.8%) people with 472 (92.4%) veins were examined. Recanalization with pathological reflux during the entire follow-up period was registered in 6 (1.3%) cases. Hence, the long-term rate of obliteration amounted to 98.7%. 1) endovenous laser ablation of major saphenous veins by means of the Mediola laser unit with wavelength of 1470 nm and single-ring radial light guides with the use of the 'Optical Handpiece MHP02 (Colibri)' made it possible to achieve obliteration of the target vein in 98.7% of cases at 6 months of follow up; 2) within the mentioned terms, the need for repeat intervention could appear in 1.1% of cases; 3) the Colibri system provides a possibility of decreasing the final cost of radial light guides for endovenous laser ablation by 30-50%.

The Efficacy of Endovenous Laser Ablation Alone as a Treatment for Varicose Veins

Introduction: Endovenous laser ablation (EVLA) of the saphenous vein has almost completely replaced surgical stripping for the treatment of saphenous vein reflux. In contrast to stripping that includes phlebectomy, EVLA is generally performed in two stages; ablation followed, when needed, by phlebectomy or sclerotherapy for branch varicose veins. However, there are several cosmetic complications after phlebectomy or sclerotherapy, such as surgical scar, haemorrhage and superficial thrombophlebitis. In our institution, a strategy is initiated to perform EVLA procedure without concomitant phlebectomy or sclerotherapy and to subsequently treat residual visible varicose veins with foam sclerotherapy if there are patients' request. This study assessed the efficacy of EVLA alone as a treatment for varicose veins. Methods: Patients undergoing EVLA alone (Radial 2Ring Fiber, ELVeS) as an initial treatment for varicose veins between September 2014 and December 2018 were enrolled. The clinical severity of venous insufficiency was graded according to CEAP classification. Patients were examined with duplex ultrasound imaging at two days, one month and one year after EVLA. Results: Seven hundred sixty-five limbs in 612 patients were included (400 females, 212 males, mean age 62 ± 13 years). Average follow-up time was 272 ± 8 days. By CEAP classification, 170 limbs were C2 (22.2 %), 348 were C3 (45.5 %), 220 were C4 (28.8 %), 10 were C5 (1.3 %) and 17 were C6 (2.2 %). Great saphenous veins (GSV) were treated in 624 extremities (81.6 %) and small saphenous veins (SSV) were treated in 141 (18.4 %) extremities. The mean diameter of GSV and SSV were 7.2 ± 0.1 mm and 6.0 ± 0.1 mm, respectively. The mean vein treatment length of GSV and SSV were 40.8 ± 0.3 cm and 16.6 ± 0.5 cm, respectively. A mean linear endovenous energy density was 57 ± 0.5 J/cm. There were no major complications such as pulmonary embolism or deep vein thrombosis. Concerning endovenous heat-induced thrombus (EHIT), class 1 were observed in 18 patients, class 2 in 26 patients and class 3 in seven patients, but no class 4. After EVLA, the rate of recanalization was 4.3%. Additional foam sclerotherapy for residual branch varicose veins was needed in 51 limbs (6.7%) for cosmetic reason. The mean time between initial treatment and subsequent procedure was 268 ± 33 days. Predictor of sclerotherapy after EVLA alone by multivariate analysis was female. Conclusion: After EVLA, only 6.7% of extremities required further treatment. Our results suggest that EVLA alone for the insufficient saphenous vein can result in improvement of symptoms and regression of visible varicosities, and the majority of patients undertaken EVLA alone might be spared unnecessary phlebectomy or sclerotherapy. Disclosure: Nothing to disclose

Same Site Recurrence is More Frequent After Endovenous Laser Ablation Compared with High Ligation and Stripping of the Great Saphenous Vein: 5 year Results of a Randomized Clinical Trial (RELACS Study)

To compare the long-term clinical efficacy of endovenous laser ablation (EVLA) with high ligation and stripping (HLS) as standard treatment for great saphenous vein (GSV) incompetence. Investigator initiated two centre randomized controlled trial with 5 year follow up. Interventions were performed on ambulatory and hospitalized patients at two vein centres, a university dermatology department (EVLA) and a specialized vein clinic (HLS). Four hundred patients suffering from GSV incompetence were assigned to EVLA or HLS of the GSV. One hundred and eighty five and 161 patients (=limbs), respectively, were treated per protocol. Main outcome measures were clinically recurrent varicose veins after surgery (REVAS classification, primary study objective), Duplex detected saphenofemoral recurrence, clinical venous severity scoring (Homburg Varicose Vein Severity Score), quality of life (Chronic Venous Insufficiency Questionnaire 2), side effects, and patient satisfaction 5 years after treatment. Two hundred and eighty one legs (81% of the study population) were evaluated with a median follow up of 60.4 (EVLA) and 60.7 months (HLS). Overall, REVAS was similarly observed in both groups: 45% (EVLA) and 54% (HLS), p=.152. Patients of the EVLA group showed significantly more clinical recurrences in the operated region (REVAS: same site): 18% vs. 5%, p = .002. In contrast, more different site recurrences were observed in the HLS group: 50% vs. 31%, p=.002. Duplex detected saphenofemoral refluxes occurred more frequently after EVLA: 28% vs. 5%, p<.001. Both treatments improved disease severity and quality of life without any difference. EVLA and HLS are comparably effective concerning overall REVAS, improvement of disease severity, and quality of life. In terms of same site clinical recurrence and saphenofemoral refluxes, HLS is superior to EVLA 5 years after treatment. ISRCTN18322872.

Endovenous laser with miniphlebectomy for treatment of varicose veins and effect of different levels of laser energy on recanalization. A single center experience.

Varicose veins, associated with great saphenous vein (GSV) incompetence, are traditionally treated with conventional surgery. In recent years, minimally invasive alternatives to surgical treatment such as the endovenous laser ablation (EVLA) and radiofrequency (RF) ablation have been developed with promising results. Residual varicose veins following EVLA, regress untouched, or phlebectomy or foam sclerotherapy can be concomitantly performed. The aim of the present study was to investigate the safety and efficacy of EVLA with different levels of laser energy in patients with varicose veins secondary to saphenous vein reflux. From February 2006 to August 2011, 740 EVLA, usually with concomitant miniphlebectomies, were performed in 552 patients. A total of 665 GSV, 53 small saphenous veins (SSV), and 22 both GSV and SSV were treated with EVLA under duplex USG. At 84 patients, bilateral intervention is made. In addition, miniphlebectomy was performed in 540 patients. A duplex ultrasound (US) is performed to patients preoccupying chronic venous insufficiency (with visible varicose veins, ankle edema, skin changes, or ulcer). Saphenous vein incompetence was diagnosed with saphenofemoral, saphenopopliteal, or truncal vein reflux in response to manual compression and release with patient standing. The procedures were performed under local anesthesia with light sedation or spinal anesthesia. Endovenous 980-nm diode laser source was used at a continuous mode. The mean energy applied per length of GSV during the treatment was 77.5 ± 17.0 J (range 60-100 J/cm). An US evaluation was performed at first week of the procedure. Follow-up evaluation and duplex US scanning were performed at 1 and 6 months, and at 1 and 2 years to assess treatment efficacy and adverse reactions. Average follow-up period was 32 ± 4 months (3-55 months). There were one patient with infection and two patients with thrombus extension into the femoral vein after EVLA. Overall occlusion rate was 95%. No post-procedural deep venous thrombosis or pulmonary embolism occurred. Laser energy, less than 80 J/cm, was significantly associated with increased recanalization of saphenous vein, among the other energy levels. EVLA seems a good alternative to surgery by the application of energy of not less than 80 J/cm. It is both safe and effective. It is a well-tolerated procedure with rare and relatively minor complications.

Endovenous laser ablation for saphenous vein insufficiency: Short- and mid-term results of 230 procedures

The present study aimed to evaluate the efficacy of endovenous laser ablation with a 1470-nm laser and to analyze the short- to mid-term results of endovenous laser ablation procedures to treat great saphenous vein insufficiency. In this retrospective study, 200 patients (230 limbs) with symptomatic varicose veins secondary to great saphenous vein insufficiency treated with 1470-nm endovenous laser ablation were studied. Patients were evaluated clinically on the first day, first week, first month, and sixth month after the operation. Treated limbs were evaluated as separate treatment events. The short-term occlusion rate was 99% and mid-term occlusion rate was 100%. Induration or swelling was the most common minor complication (13%). No major complication such as deep venous thrombosis and pulmonary embolus occurred. Preoperatively documented mean venous clinical severity score significantly reduced from 4.9±2.3 to 2.5±1.1 (p<0.05). Endovenous laser ablation procedure of great saphenous vein with a 1470-nm diode laser is a minimally invasive, safe, and efficient treatment option in all-suitable patients with high short- and mid-term success rate.

Comment to: Six-year follow-up of endovenous laser ablation for great saphenous vein incompetence, by Spreafico G, Piccioli A, Bernardi E, Giraldi E, Pavei P, Borgoni R, Ferrini M, Baccaglini U. J Vasc Surg 2013;1:20-5.

A prospective cohort study to assess the efficacy of endovenous laser ablation (EVLA) for treatment of great saphenous vein (GSV) insufficiency over a 6-year follow-up period was conducted at the Multidisciplinary Centre of Outpatient Surgery - University Hospital, Padua (Italy). Patients were recruited between January 2003 and July 2004, and the follow-up phase lasted until July 2010. Two hundred and four patients underwent EVLA procedure at the outpatient surgery unit. A 980-nm diode laser and tumescent echo color doppler (ECD) guided perivenous anesthesia were used. The most prominent varices were treated with stab-vein avulsion immediately after the EVLA procedure. All patients had to wear 35-mm Hg elastic compression stockings for 24 h daily during the first week after EVLA, and then switch to second-class graduated elastic compression stockings for 4 weeks more. Patients were scheduled for clinical and ECD assessments at 3, 7, 30, and 90 days after EVLA; and thereafter once a year, for 6 years. The main outcome of the study was the incidence of clinical (e.g., lack of improvement or worsening of leg symptoms) and ECD-confirmed (e.g., finding of measurable venous reflux in the treated segment) EVLA failures (ECEFs) during the planned 6-year follow-up period. The ECEFs were categorized as type 1 (venous reflux limited to the junction and/or the residual saphenous stump, for a maximum length of 5 cm from the junction, without reflux in its collaterals); type 2 (reflux also in a collateral vein without clinically evident recurrent varices ); or type 3 (same as 2 with clinically evident recurrent varices, either symptomatic or asymptomatic). One hundred and twenty four patients (60.8%) underwent stab-vein avulsion as well; and 65 patients (32.8%) with residual varicose veins received sclerotherapy within 12 weeks from the procedure. Fourteen (6.8%) out of 204 patients were lost for follow up. No deep vein thrombosis was detected during the follow-up period. After 6 years, 168 (88.4%) patients reported a symptomatic improvement; of them, 87 patients had no residual symptoms, and 81 experienced a significant reduction of their leg complaints. Fourteen patients complained of persistent symptoms, six reported unsatisfactory aesthetic results, and two patients had worsened skin alterations. Of these 22 patients, only two had an ECEF as well. Patients with a competent saphenous junction and a persistently occluded saphenous trunk were 70.0% (133/190); therefore, 57 (30.0%) had an ECEF. Of them, 20 patients had a type 1 ECEF, 18 had a type 2 ECEF [three of which were at the anterior accessory saphenous vein (ASSV)], and 19 had a type 3 ECEF (12 of which were at the ASSV). An atypical junction or one with a diameter &ge;8 mm and a mean trunk diameter &ge;8 mm, were highly significantly associated with ECEF. Expected EVLA results, either from a clinical or technical (ECD) perspective, were obtained in 88.4% and 70.0% patients, respectively, and persisted throughout the 6-year follow-up period. All failures were observed within the first 2 years from EVLA. The unexpectedly high (57/190; 30.0%) rate of ECEF is possibly due to the systematic application of the Valsalva maneuver during ECD; this probably accounts for the high rate of type 1 ECEF. It is likely that most of the technical failures observed will soon be eliminated thanks to the use of adequate linear endovenous energy density (LEED) (at least 70 joules/cm), which was not in use in the period studied, and to the latest implements now available.

Six-year follow-up of endovenous laser ablation forgreat saphenous vein incompetence.

Treatment of chronic venous insufficiency of the great saphenous veins by endovenous laser ablation yields good short- and medium-term results, as assessed clinically and technically by echo-color-Doppler. At present, scarce data are available on the long-term results of endovenous laser ablation. We wanted to assess the long-term efficacy of endovenous laser ablation. We performed a prospective 6-year follow-up cohort study, with recruitment between 2003 and 2004, and the follow-up completed in 2010. The setting was an ambulatory care/day surgery. Of 209 consecutive patients who underwent endovenous laser ablation at our institution during the recruitment period, five (2.4%) did not complete the procedure due to technical reasons. Of 204 patients who successfully completed the intervention, 14 (6.8%) were lost for follow-up, and 190 completed the planned 6-year follow-up. The intervention was an endovenous laser ablation using a 980-nm laser diode. Clinical and echo-color-Doppler evaluations were regularly scheduled for all patients during the planned follow-up period. The incidence of clinical and echo-color-Doppler confirmed endovenous laser ablation failures over a 6-year follow-up period. Potential associations between failures and patients' characteristics, echo-color-Doppler findings, or surgical features were also investigated. Symptomatic clinical endovenous laser ablation failures occurred in 22 (11.6%; 95% confidence interval [CI], 7.4-17.0%) patients; while 57 (30.0%; 95% CI, 23.6-37.1%) had echo-color-Doppler-confirmed failures. Only two patients (1.1%; 95% CI, 0.1%-3.8%) had both symptomatic clinical and echo-color-Doppler-confirmed failures. Three features of the great saphenous vein: an "atypical" junction, a junction diameter ≥8 mm, and a mean trunk diameter ≥8 mm, were independently associated with echo-color-Doppler-confirmed failures on multivariate logistic regression analysis. Six years after endovenous laser ablation, most patients were improved on clinical grounds, and more than two-thirds had no saphenous insufficiency at echo-color-Doppler. Only a minority had both clinical and echo-color-Doppler-confirmed failures. Anatomical features of the junction and the saphenous diameter both at the junction andat the trunk independently predicted echo-color-Doppler-confirmed failures.

Endovenous Laser Ablation of Incompetent Perforating Veins with 1470 nm, 400 μm Radial Fiber

To evaluate the efficacy of endovenous laser ablation (EVLA) of incompetent perforating veins (IPVs) with 1470 nm laser with 400 μm radial fiber. EVLA for perforating veins can be performed with insignificant postprocedural morbidity. This allows treatment to be offered to elderly patients with comorbidities that would preclude anesthesia for surgical treatment or subfascial endoscopic perforator surgery (SEPS). A total of 24 perforating veins in 16 limbs of 13 patients were treated between July 2010 and December 2011 in our clinic. Follow-up duplex scans were performed at 1 week and 1, 3, 6, and 12 months after the procedure, to determine the treatment outcome. Of the 23 treated IPVs, 20 (86.9%) were occluded on the duplex examination at 12 months. The average energy administrated per perforating vein treated was 174 J (range 105-236 J). Four of five ulcers had healed after 8 weeks in clinical-etiology-anatomy-pathophysiology (CEAP) C6 group. Two patients reported localized paresthesia, which subsided spontaneously, but no deep venous thrombosis or skin burn was observed. All components of the Venous Clinical Severity Score (VCSS) demonstrated significant improvements at each postprocedural visit (p<0.001 for all), except for pigmentation and compression, which exhibited variation throughout the follow-up period. Especially in the case of liposclerotic or ulcerated skin in the affected region, EVLA of IPVs with 1470 nm diode laser is highly effective and safe, and appears to be feasible. Additionally, repeat treatment can easily be performed should recurrence of IPVs arise.

Endovenous Laser Ablation in the Treatment of Small Saphenous Varicose Veins

The study was performed to evaluate the clinical and technical efficacy of endovenous laser ablation (EVLA) of small saphenous varicosities, particularly in relation to the site of endovenous access. Totally 59 patients with unilateral saphenopopliteal junction incompetence and small saphenous vein reflux underwent EVLA (810 nm, 14 W diode laser) with ambulatory phlebectomies. Small saphenous vein access was gained at the lowest site of truncal reflux. Patients were divided into 2 groups: access gained above mid-calf (AMC, n = 33) and below mid-calf (BMC, n = 26) levels. Outcomes included Venous Clinical Severity Scores (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ), patient satisfaction, complications, and recurrence rates. Both groups demonstrated significant improvement in VCSS, AVVQ, generic quality of life Short Form 36, and EuroQol scores (P < .05) up to 1 year. No differences were seen between AMC and BMC groups for complications (phlebitis: 2 [6%] and 1 [3.8%], P > .05; paresthesia: 2 [6%] and 5 [19%], P = .223) and recurrence (3 [9%] and 1 [3.8%], P = .623), respectively. The site of access in our study does not appear to influence complications specifically neural injury or recurrence rates.

Innovative Treatments in Chronic Venous Insufficiency: Endovenous Laser Ablation of Perforating Veins: A Prospective Short-term Analysis of 58 Cases

Objective To evaluate the efficacy of endovenous laser ablation of incompetent perforating veins. Study design Prospective cohort study. Patients A total of 58 perforating veins in 33 limbs of 28 patients were treated between March 2008 and February 2009 in an outpatient clinic setting. The average age was 65 years (range 30–81 years); 64% female; CEAP clinical stage C4 (67%), C5 (17%) and C6 (16%) (Clinica, Etiology, Anatomy and Pathophysiology, CEAP). Methods All patients underwent a standardised clinical examination and duplex ultrasonography. Guided by duplex ultrasonography, the perforating veins were cannulated percutaneously and tumescent local anaesthesia was given. An 810-nm diode laser was used to deliver 14 W power. Mean total energy delivered was 187 (range 87–325) J. Three months post-treatment, all patients underwent a further duplex ultrasound examination, to determine the treatment outcome. Results Occlusion of the perforating veins was achieved after 3 months in 78% of the cases. In the CEAP C6 group, four of five ulcers had healed after 6 weeks. No serious complications, including deep venous thrombosis, were encountered. Conclusions Endovenous laser therapy for treating incompetent perforating veins is a safe and technically feasible technique. The initial occlusion rate is acceptable.

Endovenous Laser Ablation as a Treatment for Postsurgical Recurrent Saphenous Insufficiency

The purpose of this study was to investigate the safety and efficacy of endovenous laser ablation as a treatment for recurrent symptomatic saphenous insufficiency occurring after saphenous vein ligation and stripping. A single-center retrospective review of patients who received endovenous laser ablation as a treatment for recurrent symptomatic saphenous insufficiency after ligation and stripping between November 2003 and October 2006 was performed. Fifty-six insufficient saphenous systems were identified in 38 patients. Follow-up consisted of a clinical examination in all patients as well as selective lower-extremity duplex ultrasound as clinically indicated. All 38 patients demonstrated complete closure of the insufficient saphenous vein by clinical examination and/or duplex ultrasound evaluation. Preoperative symptoms resolved after treatment in all 38 patients. No major complications were identified. Endovenous laser ablation of recurrent symptomatic saphenous venous insufficiency is a safe and effective treatment in patients who develop recurrent symptoms after saphenous vein ligation and stripping.

Endovenous laser treatment of the small saphenous vein

Endovenous laser treatment is a minimally invasive technique for ablation of the incompetent great (GSV) and small saphenous vein (SSV). Compared with the GSV, fewer data are available on SSV laser ablation and are not validated. This multicenter prospective study evaluated the feasibility, safety, and efficacy of endovenous laser ablation to treat SSVs. Between January 2003 and January 2007, 204 patients (229 limbs) with CVD and incompetent SSVs (evaluated by the CEAP classification) who were eligible for surgery underwent consecutive laser ablation procedures. Many required additional treatment for varicose tributaries and perforator veins with phlebectomy and foam sclerotherapy, Energy was delivered to the vein wall by a 600-microm optical fiber using 810-nm or 980-nm diode laser. Ablations were performed with duplex ultrasound (DU) guidance and tumescent anesthesia. Follow-up was with clinical examination and DU imaging. DU imaging showed immediate occlusion of the SSV with no thrombosis in the proximal veins. No complications occurred intraoperatively. All patients had postoperative ecchymosis, but it was minimal. Three patients had distal thrombotic complications. Superficial phlebitis after complementary surgery occurred in three cases. Complete occlusion with absence of flow </=2 months of follow-up was detected in 226 SSV (98.7%). It occurred 22 in patients with large SSV diameter. Recanalization was found in one patient at 12 months and in two patients at 24 months. Seven limbs had reflux in previously treated areas, treated segments, and segments in continuity with them. Three underwent an intervention to correct symptomatic reflux. The other four had no symptoms. After 1 year, eight limbs developed reflux in new locations and four underwent treatment. Symptoms resolved in most patients soon after the operation. The mean follow-up was 16 months (range, 2-39 months). After 8 to 12 months postprocedurally, the laser-treated veins were fibrotic and almost indistinguishable on DU imaging from the surrounding tissues. In five patients (2.25%) postoperative paresthesia occurred >2 to 3 days postoperatively and persisted in the follow-up. No paresthesia occurred in our last series whenever a larger amount of tumescent cold saline was infused around the vein. Endovenous laser ablation of the SSV has excellent early and midterm results. The prevalence of thrombosis and paresthesia is very low. Symptom relief is very good.

Endovenous Laser Ablation for Short Saphenous Vein Incompetence

Conventional surgery for short saphenous vein (SSV) incompetence has a high incidence of recurrence and is associated with neurovascular injury. The aim of this study was to evaluate the safety and efficacy of endovenous laser ablation (EVLA) as an alternative to open surgery for SSV incompetence. Data were prospectively collected for all patients undergoing EVLA for SSV disease in our unit, including clinical outcomes and postoperative duplex. There were 368 EVLA procedures performed from April 2004 through December 2007, of which 66 (18%) were for SSV incompetence. Six (9%) SSV procedures were for recurrent disease after conventional surgery. Forty (61%) procedures were performed under local anesthesia, including four patients who underwent bilateral procedures at the same session. There were no intraoperative complications, and there was no evidence of neurovascular injury. During a median follow-up of 14 months (interquartile range 6-24) there was no clinical or duplex evidence of recurrence and no recanalization of the SSV. Our early results suggest that EVLA is a safe alternative to conventional surgery for the treatment of SSV incompetence in patients with C2-C4 disease. Bilateral procedures have been performed under local anesthesia.

Initial Experience in Endovenous Laser Ablation (EVLA) of Varicose Veins Due to Small Saphenous Vein Reflux

Objective Conventional surgery for varicose veins due to small saphenous reflux is associated with high recurrence rates (up to 50%), many resulting from inadequate surgery. This prospective audit examines the safety and efficacy of EVLA in the treatment of this. Method 65 patients (68 limbs) with varicosities due to primary or recurrent sapheno-popliteal junction (SPJ) and small saphenous vein (SSV) reflux underwent out-patient EVLA (810 nm diode laser). The SSV was ablated from mid-calf to the SPJ. Symptomatic improvement (Aberdeen Varicose Vein Severity Score [AVVSS]), time to return to normal activity, post-EVLA analgesic requirements, and complications were recorded. Results Duplex ultrasound follow-up (median 6-months) confirmed abolition of SPJ/SSV reflux in all limbs following a median total laser energy delivery of 1131J (IQR 928-1364) at an energy density of 66.3 Joules/cm (IQR 54.2–71.6). AVVSS improved from 15.4 (IQR 11.8–19.7) to 4.6 (IQR 3.2–6.7) at three months (p<0.001). Median analgesia requirement was 3 days (23% [15/65] patients required none) and the median time to normal activity was 0 (0–4) days (65% [42/65] returning to normal daily activity immediately). There were no instances of skin burns or DVT but 3 patients (4.4%) developed transient cutaneous numbness (sural nerve). 98% (64/65) patients would undergo EVLT again. Conclusions EVLA abolished SPJ/SSV reflux in all limbs. This is likely to be more effective than conventional surgery, although long-term follow up is required. Data from a randomised control trial would be desirable.

Initial Experience in Endovenous Laser Ablation (EVLA) of Varicose Veins Due to Small Saphenous Vein Reflux

Conventional surgery for varicose veins due to small saphenous reflux is associated with high recurrence rates (up to 50%), many resulting from inadequate surgery. This prospective audit examines the safety and efficacy of EVLA in the treatment of this. 65 patients (68 limbs) with varicosities due to primary or recurrent sapheno-popliteal junction (SPJ) and small saphenous vein (SSV) reflux underwent out-patient EVLA (810 nm diode laser). The SSV was ablated from mid-calf to the SPJ. Symptomatic improvement (Aberdeen Varicose Vein Severity Score [AVVSS]), time to return to normal activity, post-EVLA analgesic requirements, and complications were recorded. Duplex ultrasound follow-up (median 6-months) confirmed abolition of SPJ/SSV reflux in all limbs following a median total laser energy delivery of 1131J (IQR 928-1364) at an energy density of 66.3 Joules/cm (IQR 54.2-71.6). AVVSS improved from 15.4 (IQR 11.8-19.7) to 4.6 (IQR 3.2-6.7) at three months (p<0.001). Median analgesia requirement was 3 days (23% [15/65] patients required none) and the median time to normal activity was 0 (0-4) days (65% [42/65] returning to normal daily activity immediately). There were no instances of skin burns or DVT but 3 patients (4.4%) developed transient cutaneous numbness (sural nerve). 98% (64/65) patients would undergo EVLT again. EVLA abolished SPJ/SSV reflux in all limbs. This is likely to be more effective than conventional surgery, although long-term follow up is required. Data from a randomised control trial would be desirable.