Endovenous Laser Ablation Treatment Research Articles

The level of occlusion of small saphenous vein after endovenous laser ablation

<p><strong>Aim <br /></strong>To determine the success of endovenous laser ablation (EVLA) treatment and long-term occlusion of small saphenous<br />vein (SSV), as well as factors and conditions that influence the effectiveness of EVLA treatment.<br /><strong>Methods</strong> <br />A total of 250 patients treated with EVLA method over a period of seven years were followed one year after treatment.<br />The main factors monitored and recorded during EVLA treatment were laser power (W), amount of delivered energy (J), duration of treatment (sec), veins length (cm), diameter (mm) and reflux (sec).<br /><strong>Results</strong> <br />Within the first six months, the recanalization or insufficiently occluded SSV was noticed in ten, and after one year in<br />one patient. The overall assessment of occlusion and satisfactory findings after one year of SSV was 95.6%.<br /><strong>Conclusion <br /></strong>It is important to choose adequate power and the amount of delivered energy. The physician’s assessment and selection<br />of an adequate patient greatly improves the outcome of the treatment. It is important to treat larger branches and double SSV between two fascias. Successful and effective EVLA treatment greatly reduces the possibility of recanalization of the treated vein.</p>

Effectiveness of iliac vein stenting combined with endovenous laser treatment of recurrent varicose veins associated with iliac vein compression.

Iliac vein compression syndrome (IVCS) is an underlying cause of varicose vein (VV) recurrence after venous surgery. However, the management of recurrent varicose veins (RVVs) combined with IVCS has rarely been reported. This study aimed to investigate the outcomes of a one-stop procedure to correct outflow obstruction and superficial reflux for patients with RVVs and IVCS. A retrospective analysis was conducted of 102 consecutive patients diagnosed with RVVs. Computed tomography venography (CTV) was performed to confirm IVCS. The cases were divided into 2 groups: the IRVVs group, including patients with RVVs and IVCS (n=48), and the RVVs group, including patients with RVVs only (n=54). The characteristics, vein reflux, and clinical, etiological, anatomical, and pathophysiological (CEAP) distribution were investigated. Then, the IRVVs group patients who underwent endovenous laser ablation (EVLA) (n=39) were divided into a further 2 groups: the EVLA + S group (n=19), who received EVLA and stenting of iliac vein, and the EVLA group (n=20), who received EVLA treatment alone. The great/small saphenous vein (GSV/SSV) trunk occlusion, VV recurrence, visual analogue scale (VAS), and venous clinical severity score (VCSS) were investigated. The prevalence rate of femoral vein reflux was 81.2% in IRVVs group and 50% in RVVs group (P<0.05). In the IRVVs group, 72.9% of patients manifested as CEAP clinical class >3, which was higher than that in RVVs group (48.1%) (P<0.05). The 12-month GSV/SSV occlusion rate in the EVLA + S and EVLA groups were 94.7% and 90.0%, respectively. Totals of 9 patients in EVLA + S group and 6 patients in EVLA group had active venous ulcers, and the ulcer healing time in EVLA + S group was significantly shorter (27.22±7.12 vs. 46.67±9.83 days, P<0.05). The reductions in the VAS and VCSS values between baseline, 1 month, and 12 months in the EVLA + S group were more obvious than those in EVLA group (P<0.05). The one-stop combination treatment of iliac venous stenting and EVLA in patients with RVVs and IVCS is safe and effective and provides prominent symptom relief, improved quality of life, and a more satisfactory ulcer healing than EVLA alone.

Combining Proximal Foam Sclerotherapy and Distal Endovenous Laser Ablation for Recurrent Varicose Vein Treatment.

Recurrent varicose veins with neovascularization are a common clinical problem. Although endovenous laser ablation (EVLA) has become the standard treatment modality to treat truncal veins, additional sclerotherapy is required to treat newly formed tortuous veins. A novel laser fiber with an injection channel (nLF) allows for such simultaneous proximal sclerotherapy and offers a potentially more effective treatment option. The aim of this study was to present our experience using the nLF for combined EVLA and sclerotherapy treatment of symptomatic recurrent varicose veins. A retrospective single-center cohort study analyzed the outcomes of all patients with symptomatic recurrent varicose veins, treated with an nLF between September 2020 and August 2022. In total, 28 combined EVLA/sclerotherapy procedures performed with the nLF in 26 patients were analyzed. In all cases, neovascularizations were treated by sclerotherapy through the nLF catheter, followed by laser ablation of the remaining truncal veins. All follow-up ultrasound examinations showed persistent complete occlusion of the treated truncal veins and neovascularizations. No clinically relevant complications were observed. Combining proximal foam sclerotherapy and distal EVLA using an nLF for the treatment of symptomatic recurrent varicose veins is safe and effective.

Comparison of Non-Tumescent n-Butyl Cyanoacrylate and Endovenous Laser Therapy in Saphenous Vein Ablation

Objective: Ablation of N-butyl cyanoacrylate (NBCA) and endovenous laser ablation (EVLA) are two important techniques used in the treatment of venous insufficiency. The aim of this study is to compare the results of EVLA and NBCA methods in the treatment of saphenous vein insufficiency. Method: 739 patients with saphenous vein insufficiency who were followed up between 2013 and 2018 and treated with NBCA (350 patients) and EVLA (389 patients) applications were included in the study. Pre-procedure, during, post-procedure and follow-up data of the patients were collected and compared retrospectively. Results: In the group using NBCA technique; mean age was 46.09±6.12 years, mean age was 48.08±6.11 years in the EVLA technique group. The mean ablated vein length was 32.97-65.83 cm in the NBCA group and 30.65-67.25 cm in the EVLA group. The mean procedure time was 7 minutes in the NBCA group and 18 minutes in the EVLA group. The 12-month total occlusion rates in the NBCA and EVLA groups were 98.8% and 97.6%, respectively. In both the NBCA and EVLA groups, the post-procedure Venous Clinical Severity Score (VCSS) was significantly reduced with no difference between the groups. When NBCA treatment was compared with EVLA treatment, it was seen that there may be fewer side effects after NBCA treatment. Conclusion: When the treatment success rates, application times, complication rates and venous clinical severity scoring results in the data obtained in our study were evaluated, it was thought that the NBCA method was as successful and reliable as the EVLA method. In conclusion; It has been suggested that the vascular closure system with NBCA is a fast and effective treatment method in the treatment of saphenous vein insufficiency, as it does not require tumescent anesthesia, does not require compression stockings, and does not have the risk of paresthesia, burn scars or pigmentation.

Comparison of Short-Term Outcomes Between Endovenous 1,940-nm Laser Ablation and Radiofrequency Ablation for Incompetent Saphenous Veins.

Background: Radiofrequency ablation (RFA) has shown faster recovery and lower pain scores compared to Endovenous laser ablation (EVLA) for treatment of varicose veins. However, a comparison of 1,940-nm EVLA and RFA has not been reported. This study compared short-term outcomes using 1,940-nm EVLA and RFA for varicose veins.Methods: Between April 2018 and June 2018, 43 patients (83 incompetent saphenous veins) were treated with 1,940-nm EVLA and 37 patients (64 incompetent saphenous veins) with RFA. Follow-up duplex was checked at 1 month and 3 months.Results: Baseline characteristics showed no significant differences between both groups except for age. Pain scores at 6 h, and at 1, 10, and 30 days after treatment showed no differences. Complications and time to return to normal activity showed no differences. The 100% closure rate was checked in both groups at 1 month and 3 months follow-up.Conclusion: Short-term outcomes showed no significant differences between 1,940-nm EVLA and RFA treatment.

Treatment of varicose great saphenous veins with saphenofemoral junction insufficiency – what is the evidence? *

AbstractThe results of studies on treatment of the great saphenous vein (GSV) with sapheno-femoral-junction (SFJ) insufficiency are unclear. Guidelines, however, recommend endovenous laser ablation (EVLA) and ultrasound-guided-foamsclerotherapy (UGFS) for symptomatic varicose large saphenous vein. There are numerous studies on GSV treatment but only a few randomized studies with a follow-up of two years and more. Meta-analyses in most instances included all studies and do not focus on studies with a follow-up of two years and longer. Methods A literature research in Pubmed used the keyword “great saphenous vein treatment”, “large saphenous vein treatment”, “varicose therapy” in conjunction with “randomized controlled trial”, “meta-analysis” and “systematic review”. Of 128 studies only 24 randomized controlled studies investigated the effect of High Ligation and Continuous Stripping (HL + CS), Endovenous Laser Ablation (EVLA), Radiofrequency Ablation (RFA), Liquid Sclerotherapy (LS), and Ultrasound-Guided-Foam-Sclerotherapy (UGFS) and a follow-up of two and more years. Study evaluation included “reflux”, “recurrence”, “therapy technique”, numbers of patients/legs treated, length of follow-up, and primary/secondary study endpoints. Results Most of these studies investigated surgical High Ligation and Continuous Stripping (HL + CS) with a follow-up of two years and more. This technique served a reference technique for other techniques in randomized controlled studies. However, there are major differences in techniques, mode of treatment, definitions, criteria for exclusion and inclusion, and study endpoints.The surgery study group included 1915 legs in 19 studies, the EVLA group 1047 legs in 12 studies and 240 legs in 3 studies with combined HL + EVLA treatment. RFA was used in 299 legs in 4 studies, UGFS in 661 legs in 5 studies, combined UGFS + HL in 39 legs and LS + HL in 92 legs in one study each.EVLA is associated with more reflux and recurrence when compared to HL + CS. RFA shows similar reflux and recurrence rates as surgery. In most studies UGFS and LS is followed by more reflux and recurrence when compared to surgery. Conclusion Due to heterogeneity of studies comparing study results of HL + CS, EVLA, RFA, LS and UGFS is not reliable. UIP or ECOP may form a commission to establish uniform, reliable and accepted study designs for varicose vein treatment to improve comparability of further randomized studies.

Great saphenous varicose vein treatment with endovenous ablation techniques: A comparison of EVLA and RF

Aim: In this study, we compared the clinical follow-up results and complication and success rates of patients undergoing 1470 nm wavelength endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) in our clinic.Material and Methods: The records of 581 patients treated in our clinic due to clinical symptoms arising from great saphenous vein insufficiency between January 2014 and September 2018 were examined retrospectively. Three hundred fifty-seven of these patients treated with EVLA or RFA and with no deficient data were included in the study. Patients with reflux in the saphenofemoral junction lasting at least 0.5 sec, with a great saphenous vein diameter of at least 7 mm, 2 cm distal to the saphenofemoral junction, and of at least 5.5 mm at knee level, and with CEAP stage C2-C5 were scheduled for endovenous ablation. The patients were randomly distributed between the established EVLA and RFA treatment groups. Data for patients’ diagnostic and therapeutic processes were recorded and evaluated in the light of information in the literature. Results: The EVLA group consisted of 86 patients (42 male, 44 female; mean age 46 years, range 26-71), and the RFA group of 271 (113 male, 158 female; mean age 43.3 years; range 20-77). The mean follow-up time was 27.2 months. No significant differences were determined in terms of patients’ demographic data, preoperative additional diagnoses, CEAP classification values, duration of reflux, or proximal and distal great saphenous vein diameter values. Thrombophlebitis developed in 14 patients and ecchymosis/hematoma in 32. No significant difference was observed between the groups in terms of complications. Great saphenous vein occlusion rates at Doppler ultrasonography six months after treatment were 91.8% in the EVLA group and 94% in the RFA group (p=0.46). Conclusion: Our results suggest that neither of the two endovenous ablation methods is superior to the other.

Evaluation of Postprocedural Pain and Quality-of-Life Improvement in Rural Patients with Chronic Venous Insufficiency Undergoing Endovenous Laser Ablation

Abstract Background Chronic venous insufficiency (CVI) manifests as unilateral or bilateral lower-limb venous hypertension causing pain, swelling, edema, and skin changes, among other symptoms. CVI affects patients’ socioeconomic status, is particularly seen in the young, and, in its severe manifestation, may have a debilitating effect on patients’ quality of life (QoL). The authors wanted to evaluate change in pain and QoL among rural patients after endovenous laser ablation (EVLA) treatment in a pilot study. Methods Twenty patients having CVI who opted for 1,470-nm EVLA treatment were enrolled at the Interventional Radiology department between July 2018 and September 2018. The authors evaluated pain using the visual analog scale (VAS) before and after EVLA procedure (standard protocol) of the affected vein. They also assessed QoL using the Aberdeen Varicose Vein Questionnaire before and 6 weeks after EVLA. Results The authors observed significant reduction in pain postprocedure versus preprocedure. Majority of the patients had improvement in itching and stasis dermatitis after the procedure. Rash and skin ulcers remained uncommon before and after EVLA. Also, after EVLA, fewer patients than before reported that the appearance of their diseased veins caused them concern (35 vs. 65% before EVLA), influenced their choice of clothing (45 vs. 80%), interfered with their work (40 vs. 90%), and interfered with their leisure activities (30 vs. 80%). Conclusion EVLA 1470nm procedure may help patients with CVI attain improved QoL and significant pain reduction.

Endovenous Laser Ablation with 1,470-nm Diode with Tumescence Anesthesia and Saphenofemoral Ligation: Propensity Score Match Comparison

The aim of this study is to compare 2 groups of patients treated for great saphenous vein (GSV) reflux with open surgical saphenofemoral ligation (SFL) and endovenous laser ablation (EVLA). Consecutive patients with primary unilateral GSV reflux undergoing EVLA treatment since 2014 were enrolled, and another series of patients treated with SFL was considered. The patients were stratified according to treatment and the results were compared using the propensity score (1:1). The covariables were age, gender, body mass index, CEAP (Clinical class, Etiology,Anatomy and Pathophysiology) staging, and GSV and saphenofemoral junction diameters. Primary outcomes were GSV occlusion or recurrent groin varicose veins at 1 year after treatment. Secondary outcomes included vein thrombosis, hyperpigmentation, paresthesia, postoperative pain, analgesic requirement, and ecchymosis assessed at discharge and CEAP stage and quality of life (QoL) assessment 1 month after surgery. A total of 123 patients were included in the study: 59 were treated with EVLA and 64 with SFL. At 12months, we observed 10 recurrent groin varicose veins after SFL (15.6%) and 6 GSV recanalization after EVLA (10.2%, P=0.369). Extra-saphenous recurrent varicose veins were observed in 36 patients (29.3%): 20 in the open group (31.2%) and 16 in EVLA group (27.1%, P=0.615). After matching procedure 74 patients were analyzed (37 patients by group), logistic regression model showed that the risk of outcome was not associated with the surgical treatment (odds ratio 1.76, 95% confidence interval 0.52-6.01). Both techniques to treat saphenous impairment have demonstrated to be safe, with good results in terms of efficacy and symptomatic improvement at follow-up. EVLA with 1,470nm seems to have lower rates of recurrence and good perceived QoL. Tumescent anesthesia is a good option with good results and may be extended to open surgical ligation.

Influence of linear intravenous energy density on the success of intravenous laser ablation for treatment of chronic venous insufficiency.

BackgroundIt is relevant to elucidate the influence that mean linear endovenous energy density (LEED) has on the success of endovenous laser ablation treatment for chronic venous insufficiency, in order to reduce the method’s adverse effects.ObjectivesTo evaluate the influence of mean LEED on the prevalence of saphenous closure 30 days after the laser ablation procedure.Methods153 lower limbs from 118 patients seen at a tertiary hospital and treated for chronic venous insufficiency with endovenous 1470 nm laser ablation under local anesthesia were evaluated. The mean LEED used to treat patients was calculated to determine whether greater than average LEED was required for treatment success.ResultsA significant difference (p = 0.021) in saphenofemoral junction closure was associated with mean LEED used above the knee. Conversely, there was no significant difference in the thigh segment.ConclusionsLinear intravenous energy density greater than the mean of 70.57 J/cm was associated with a higher rate of closure at the saphenofemoral junction. However, density did not have an influence on the result for the thigh segment, showing that an energy density exceeding 70.57 J/cm tends not to be required for treatment of this segment.

A Study of Endovenous Laser Ablation Treatment of Varicose Veins in Patients Orally Administered Anticoagulant

A Study of Endovenous Laser Ablation Treatment of Varicose Veins in Patients Orally Administered Anticoagulant

Day surgery versus Outpatient setting for endovenous laser ablation treatment. A prospective cohort study

ObjectivesThe traditional surgical approach to the treatment of the superficial venous insufficiency requires at least 12 h of post-operative monitoring and this often means the necessity of an overnight hospitalization. The introduction of new, less invasive techniques (i.e endovenous laser ablation) reduces the hospitalization stay in a Day Surgery setting. However, the increasing skills of the operators and the patient's selection, allows to propose endovenous laser ablation in an Outpatient setting. The aim of this study is to evaluate the activity of a single high-volume center. MethodWe enrolled 112 consecutive patients with great sapehous vein insufficiency and indication to endothermal laser ablation, 57 operations (51%) were performed in Day Surgery setting and 55 (49%) in Outpatient setting according to endovascular laser ablation's criteria. Past medical history, CEAP classification, VCSS score, type of symptoms and intervention's data were collected. Post-operative results (success and complications rates, patient's functional and aesthetic satisfaction) were evaluated at 7 and 30 days after intervention. A QoL questionnaire (CIVIQ) was submitted to the patients 30 days after surgery. ResultsWe did not observe a statistically significant difference between the two groups concerning treatment results and complications onset. The QoL assessment did not differed significantly, except for over 65-year old patients undergoing outpatient treatment that showed a better QoL compared to those undergoing the same treatment in Day Surgery (p 0.05). ConclusionsThe endothermal laser ablation technique allows a safe, comfortable and faster management of the venous disease in Outpatient setting. This would further reduce the costs of the treatment while preserving the functional and aesthetic results and the low complication rate of the Day Surgery setting.

Results of a long-term performance and follow-up of Endovenous Laser Ablatıon procedures performed for treating great saphenous vein incompetence.

Objective:To assess the value of endovenous laser ablation (EVLA) for treating great saphenous vein (GSV) incompetence.Methods:We reviewed the overall results of EVLA procedures performed on 554 patients in our clinic between March 2011 and December 2015. Evaluations were made concerning the situations of the great saphenous vein (GSV), the energy used in the treatments, and the results obtained. We also investigated if there was a possibility to detect failure of EVLA treatment at an early stage.Results:From a total of 657 GSVs that were subjected to EVLA treatment, the procedure was found to be successful for 611 GSVs and unsuccessful for 46 GSVs (success rate: 93%). In 38 of the 46 GSVs, a thrombus formation was detected by color Doppler ultrasonography (CDUS) at the postoperative first month (82.6%).Conclusion:EVLA is a reliable and successful method utilized for the treatment of GSV incompetence. It is concluded that the detection of a thrombus in the GSV tract during the first postoperative follow-up month is an indicator for revascularization.

Post ablation recanalization of varicose veins of the limbs: Comparison ablation method of mechanochemical and laser procedure

Endovenous ablation has been performed for varicose veins of the limbs in Indonesia since 2010. Endovenous laser ablation (EVLA) therapy has been performed in Cipto Mangunkusumo Hospital (RSCM) in Jakarta, and mechanochemical ablation (MOCA) has been conducted in Fatmawati Hospital. This was a descriptive analytical study, with a cross-sectional design to analyze post-ablation recanalization after MOCA and EVLA procedures. Patients who had undergone MOCA or EVLA treatment were interviewed 3–18 months after the procedures. All the patients underwent vascular ultrasonography (USG) of the operated limb to assess recanalization. Secondary presurgery data were obtained from the patients’ from patients’ medical records. The clinical characteristics of the subjects were recorded to compare the potential correlation between these characteristics and recanalization post-MOCA and EVLA procedures. All the data were analyzed using SPSS ver. 20.0. The study consisted of 43 limbs: 24 treated by MOCA and 19 treated by EVLA. Most subjects in the MOCA group were <60 years (20/24), and 16 of the subjects were women. In the EVLA group, nine patients were <60 years, and 19 were ≥60 years, 15 of whom were women. The body mass index (BMI) of the majority (18/24) of the subjects in the MOCA group was normal, whereas most of the patients in the EVLA (10/19) group were overweight. In the MOCA group, the largest diameter of the vena saphena magna (VSM) in 20/24 extremities prior to treatment was VSM 4–7 mm, whereas the largest diameter in the EVLA group prior to treatment was >7 mm in 13/19 extremities. In the MOCA group, total recanalization occurred in 2/24 extremities, and partial recanalization occurred in 8/24 extremities. In the EVLA group, total recanalization occurred in 1/19 extremities, and partial recanalization occurred in 3/19 extremities. The association between the clinical characteristics of the patients and recanalization was not statistically significant (p > 0.05). The recanalization tendency was higher in the MOCA group than in the EVLA group. Although there was no statistically significant association between the clinical characteristics of the patients and recanalization, the largest diameter of the VSM presurgery (>7 mm) was higher in 3/4 extremities in the MOCA group, as compared to 3/13 extremities in the EVLA group.

More Successful Results with Less Energy in Endovenous Laser Ablation Treatment: Long-term Comparison of Bare-tip Fiber 980 nm Laser and Radial-tip Fiber 1470 nm Laser Application

Varices and venous insufficiency are common and serious health problems in the general population which affect the quality of life. Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux, and the endovenous laser ablation (EVLA) method has been widely accepted all over the world. In this method, ablation is provided by a laser fiber inserted into the lumen of the vein. Initially, the fibers were 810nm, but today the fibers are usually 940, 980, or 1470nm. The study included 400 patients (419 procedures) who were diagnosed with venous insufficiency and underwent 980 and 1470nm EVLA. Patients were followed up for 48months. A 980-nm bare-tip laser catheter in Group A and a 1470-nm radial-tip laser catheter in Group B were inserted until they were 2cm below the saphenofemoral junction. An EVLA catheter was drawn slowly at the rate of 1-3 cm/sec (2.08±0.6). The energy applied to the saphenous vein was 60-120J/cm (84.65±13.03) and 45-120J/cm (76.95±15.06) in Group A and Group B, respectively (P<0.001), with 15W in the continuous mode. Follow-up visits included a physical examination and Doppler ultrasonography performed at the following time points: day 1, week 1, and months 1, 6, 12, 24, 36, and 48. Saphenous vein occlusion rates and postprocedure saphenous vein diameters were evaluated at each follow-up visit. Pain levels were evaluated using the Wong-Baker FACES® pain scale (0-10). Postoperative complications were recorded. Group A (980nm laser) consisted of 200 patients with a mean age of 37.84±12.2years. Group B (1470nm laser) consisted of 200 patients with a mean age of 38.38±12.1years. The mean duration of the procedure was 32.2±9.7min in Group A and 31.7±8.8min in Group B, respectively (P=0.47). Induration, ecchymosis, and paresthesia rates were significantly higher in the bare-tip laser group. The most important complication, deep vein thrombosis, was observed in 4 patients in Group A. Recanalization rates were found to be increased by prolonged follow-up periods. At the 48-month follow-up, this rate was 15.9% in Group A and 8.3% in Group B (P=0.017). This rate showed that the 1470-nm wavelength laser treatment was more successful in Group B than in Group A over the long term. Both the 980 and 1470nm wavelength laser-assisted EVLA procedures appear to be effective in treating saphenous vein insufficiency. The 1470-nm radial-tip fiber is preferred due to lower energy levels, lower complication rates, early return to daily life, and the successful long-term occlusion rate.

Comparison of ultrasound-guided endovenous laser ablation and radiofrequency for the varicose veins treatment: An updated meta-analysis

PurposeTo investigate and compare the relative efficacy, recurrence and complications of endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) for the treatment of varicose veins patients. MethodsSearches were applied to the Cochrane Library as well as MEDLINE, EMBASE, BIOSIS databases. 12 articles published in English (10 randomized controlled trials and 2 cohort study) were identified from specialized trails. Fixed effect model and Random effect model were applied to compare the vein ablated length, pain scores (3days and 10days), quality of Life, occlusion, over all complication, thrombophlebitis, haematoma and recanalization between the EVLA and RFA group. The results were expressed as odds ratio (OR) or relative risk (RR) and 95% confidence intervals (CI) for categorical outcomes. Results12 reported studies with a combined total of 1577 patients were included. vein ablated length (SMD:0.37, 95%CI: 0.04 to 0.77), 3days pain scores (SMD:11.25, 95%CI: 3.42 to 25.92) and 10days (SMD:0.79,95%CI: 0.48 to 2.05),1 month quality of Life (SMD: 0.09,95%CI: 0.28 to 0.10) and 1 year (SMD: 0.04,95%CI: 0.21 to 0.13), occlusion (OR:1.05,95%CI:0.41 to 2.73), thrombophlebitis (RR:1.03,95%CI:0.56 to 1.92), haematoma (OR:1.55, 95%CI:0.54 to 4.45) and recanalization (OR:0.68,95%CI:0.43 to 1.09) following RFA showed no difference when compared with EVLA. These results were not statistically significant. RFA was associated with the lower overall complication (OR: 3.49, 95%CI:1.36 to 8.96) in patients with varicose veins compared to the EVLA treatment. ConclusionEVLA and RFA seem to be the same safe and effective on clinical efficacy (vein ablated length, 3days and 10days pain scores, 1 month and 1 year quality of life, occlusion, thrombophlebitis, haematoma and recanalization). Data on RFA seems to having potential benefits from reducing risk of overall complication than EVLA, which is needed by large high-quality prospective randomized trials.

Efficacy and Safety of Endovenous Laser Ablation in Very Large and Tortuous Great Saphenous Veins

PurposeTo investigate the efficacy and safety of endovenous laser ablation (EVLA) with high energy delivery in large great saphenous veins (GSVs) at 1-year sonographic follow-up. Materials and MethodsRetrospective review of 385 patients who underwent EVLA between August 2011 and September 2013 was conducted, and 44 consecutive patients (21 women [47%]; mean age, 41 y; range, 23–66 y) with 49 large GSVs were included. Vein size and clinical follow-up results were recorded. A 600-μm bare-tipped 1,470-nm laser fiber was used for the EVLA procedure. Intended energy delivery was 150 J/cm (10 sessions at 15 W) for proximal GSV segments less than 20 mm in diameter and 195 J/cm (13 sessions at 15 W) for larger veins. Improvements in clinical and quality-of-life scores at 6 months were assessed with three validated scoring systems. ResultsMean GSV diameter was 16.95 mm (range, 15–26 mm). Five patients had GSVs at least 20 mm in diameter. Technical success was observed in 48 GSVs (97.9%) at 1-month follow-up. A second EVLA treatment was performed in one case and achieved closure, for a GSV occlusion rate of 100% at 6 months. All patients showed significant clinical improvement on all three scoring systems (P < .001). One-year follow-up was completed in 48 of 49 cases (98%). No recanalization was observed at 1-year follow-up, and there were no major complications. ConclusionsSonographic follow-up at 1 year shows that EVLA is an effective and safe procedure with excellent technical success rates in the treatment of large GSVs.

Endovenous laser ablation treatment with 980 nm diode laser for saphenous vein insufficiency: 6 months follow up results.

Superficial venous insufficiency is a common problem associated with varicose veins which, if untreated, may progress to venous ulceration. Endovenous laser ablation (EVLA) is a new, minimally invasive method for management of superficial venous insufficiency and varicose veins. The aim of this study was to demonstrate the effectiveness of 980 nm EVLA for treatment of symptomatic saphenous venous insufficiency and to present its early outcomes. Thirty-eight great saphenous veins and 5 small saphenous veins in 40 patients with saphenofemoral reflux were treated with 980 nm diode endovenous laser equipment. The diameter and length of the vein treated, total laser energy and energy density (Joules/cm) delivered were recorded. To determine the severity of the venous disease Venous Clinical Severity Score (VCSS) and Visual Analogue Scale (VAS) were used. Patients were followed up for 6 months after the procedure. Complications were recorded prospectively. Forty-three saphenous veins in 40 patients were treated. The mean age of the patients was 39.9 (range 21-72) years. The mean diameter and length of the veins were 4.9 mm (range, 3.5 to 8.5 mm) and 30.2 cm (range, 16 to 50 cm), respectively. At 6 months follow-up, total occlusion rate was 95.4% (41/43), and recanalization rate was 4.6%. Significant decrease was observed for VCSS and VAS scores after the procedure. No major complication was detected. EVLA treatment for superficial venous insufficiency is safe and can be carried out under local anaesthesia in an outpatient setting with good patient satisfaction and low complication rates.

A case of high-output heart failure caused by a femoral arteriovenous fistula after endovenous laser ablation treatment of the saphenous vein

Endovenous laser ablation treatment has become the less invasive therapeutic choice for the treatment of superficial venous insufficiency and varicose veins. A 64-year-old woman presented at our hospital with varicose veins and prior endovenous laser ablation treatment. The patient had high-output heart failure caused by a right femoral arteriovenous fistula. She was treated medically and underwent an open repair of the right superficial femoral artery and the right femoral vein with complete resolution of the arteriovenous fistula and heart failure. Here, we have reviewed the literature and discussed possible causes of the complication of arteriovenous fistula after endovenous laser ablation treatment.

Outcome of endovenous laser ablation of varicose veins.

ABSTRACTIntroduction:In Bosnia and Herzegovina according to available data, treatment of incompetent superficial lower extremity varicose veins by endovenous laser ablation (EVLA) has been introduced two years ago and so far no paper has been published regarding results of EVLA treatment of patients from our country. We wanted to present our results with EVLA treatment.Aim of study:to evaluate and compare primary posttreatment outcomes of endovenous laser ablation (EVLA) with classical surgical method of varicose vein treatment.Patients and methods:The study was clinical and prospective. It was carried out at Clinic for vascular surgery in Sarajevo where fifty-eight (58) patients received surgical treatment for varicose veins and in Aesthetic Surgery Center “Nasa mala klinika” in Sarajevo were sixty-one (61) patients with varicose veins were treated by endovenous laser ablation. Total 119 patients (limbs) with pathologic reflux only in great saphenous vein were evaluated between 1st of January 2013 and 31st of April 2014. Following primary outcome endpoints were evaluated smean day of return to normal everyday activities, patient subjective quantification of pain during first seven days after intervention, incidence of deep venous thrombosis (DVT), incidence of wound bleeding requiring surgical intervention, incidence of peri-saphenous vein hematoma and infection rate.Results:Mean of return to normal activities (expressed in days after intervention); EVLA vs. stripping (surgery) =1.21vs12.24, T test 13,619; p=0, 000, p<0,05. T test was used for comparing Mean value of visual pain analog scale for the first 7 days between groups, for all seven days pain was significantly higher in surgical group of patients as compared to EVLA group; p<0,05. Incidence of hematoma greater than 1% of total body surface area was significantly higher in patients receiving surgical treatment; Pearson Chi Square=23,830, p<0,05; odds ratio:10,453. Incidences of infection, deep venous thrombosis and posttreatment bleeding were not statistically different between analyzed groups; EVLA vs Surgery (Pearson Chi Square =3,237; p>0,05; Pearson Chi Square=2,139, p>0,05, Pearson Chi Square=2,139, p>0,05, respectively.)Conclusion:EVLA offers better patient recovery in terms of significantly lower post treatment pain, faster return to everyday activities and lower incidence of bruising (hematomas).