Recurrent Varicose Research Articles

Erratum to: Embolization of Incompetent Pelvic Veins for the Treatment of Recurrent Varicose Veins in Lower Limbs and Pelvic Congestion Syndrome

Erratum to: Embolization of Incompetent Pelvic Veins for the Treatment of Recurrent Varicose Veins in Lower Limbs and Pelvic Congestion Syndrome

Analysis of a Series of Patients with Varicose Vein Recurrence

Varicose veins of the lower extremities is a common clinical condition. Although surgical treatment is often successful, the recurrence rate remains high. This retrospective study evaluated the reasons for postoperative recurrence of varicose veins by analysing ultrasonography and venography findings in patients with recurrent disease. A series of consecutive cases of recurrent varicose veins of the lower limbs was reviewed. Data collected included clinical characteristics, symptoms and vascular imaging. The study included 109 legs with recurrent varicose veins (92 patients): 101/109 legs (92.7%) showed perforating vein insufficiency and 86/109 (78.9%) showed reflux of the superficial femoral vein, of varying degrees of severity. Residual saphenous vein was recorded for 82 legs (75.2%), while 19 (17.4%) had blocked iliac veins due to post-thrombotic syndrome. Several factors that may contribute to varicose vein recurrence have been identified. These include failure to ligate perforating veins and initial failure to perform the appropriate surgical intervention. Prevention of varicose vein recurrence after surgical correction requires a more extensive use of preoperative imaging, to tailor surgical intervention to suit individual patients.

Embolization of Incompetent Pelvic Veins for the Treatment of Recurrent Varicose Veins in Lower Limbs and Pelvic Congestion Syndrome

We present our experience with embolization of incompetent pelvic veins (IPV) in women with recurrence of varicose veins (VV) in lower limbs, as well as symptoms of pelvic congestion syndrome (PCS), after first surgery. In addition, we evaluated the effects of embolization in decreasing the symptoms of VV before surgery as well as its effects on PCS symptoms. We included 10 women who had consulted a vascular surgeon because of recurrent VV in lower limbs after surgery. All of these patients were included in the study because they also had symptoms of PCS, probably due to IPV. In patients who had confirmed IPV, we performed embolization before a second surgery. VV and PCS were assessed before and at 3months after embolization (before the second surgery) using a venous clinical severity score (VCSS) and a visual analog pain scale (VAS), respectively. Patients were controlled between 3 and 6months after embolization. Paired Student t test analysis was used for comparing data before and after embolization. Fifteen vein segments in 10 women were suitable for embolization. There was a significant (p<0.001) decrease of VCSS after embolization, and recurrence of VV was not detected within a period of 6months. There was also significant (p<0.01) relief of chronic pelvic pain related to PCS evaluated using VAS at 3months after embolization. Embolization decreases the risk of VV recurrence after surgery and also improves PCS symptoms in women with VV in lower limbs and IPV.

RESULTS TO 5 YEARS AFTER ENDOVENOUS LASER TREATMENT

Introduction: To refer and to discuss the appearance of recurrent varicose veins after many years from the endovenous laser treatment of the refluent saphenous axis. Patients and methods: 191 laser procedures have been carried out in the period between December 2001 and June 2009 at the Center of Phlebolymphology of the Siena University for the treatment of 188 patients with varicose veins of the lower limbs. 145 patients are females and 46 males, ranging in age between 22 and 80 years. The superficial chronic venous insufficiency was caused by the incompetence of the saphenofemoral junction (SFJ) and the reflux of the great saphenous vein (GSV), as demonstrated by duplex scanner. All patients were operated under local anesthesia and sonographic guidance. A diode laser of 810 nm has been used in the first 71 procedures and a diode laser of 980 nm in the following 120 procedures. The fiber laser is introduced for transcutaneous way or after small surgical cutaneous incision from the bottom to the top with the tip that arrives to 2 cm from the saphenofemoral junction, in way to leave effluent the epigastrica vein. The employed parameters have been 12- 14 watt of power with 3 impulses of 1 second according to repeated after an interval of 1 second every cm of length of the vein, thus to obtain a fluence of approximately 40 joule for cm. Results: The immediate obliteration of the saphenous axis has been had in 182 cases (95%). The ricanalization of the great saphenous vein has been documented in the instrumental follow up in 11 patients (10,2%) at 3 years from the treatment, in 9 (12%) at 4 years and in 9 (25,7%) after 5 years. Conclusion: The endovenous laser treatment for the therapy of varicose veins of the lower limbs is a simple procedure, poor invasive, that it can be performed in outpatient or Day Surgery regime without increase of the costs of stay in hospital. Its effectiveness currently is put in argument from the possibility that a recurrent varicose veins appears at distance of years from the treatment with ricanalization of the saphenous axis, even if in absence of symptomatology. In our experience this possibility has evidenced in the clinical and instrumental follow up of the patients operated after 5 years in a percentage that exceeds the 20%.

Successful reduction of clinical relevant neovascularization with a modified crossectomy combined with a barrier technique after 10-year follow-up

The aim of this retrospective study was to assess the long-term results of stripping the insufficient great saphenous vein (GSV) with stump coagulation, closure of the cribriform fascia and some additional measures, which will be described in detail. Patients treated from 1998 to 1999 for varicose veins had been invited in 2009 for follow-up colour-coded duplex sonography and had been asked to answer a quality-of-life questionnaire. In 2009, the examinations for the study were conducted at a clinic of angiology by an independent and experienced sonographer. From a total of 165 patients, 91 (136 limbs) had been willing to participate in the study. Duplex ultrasound after a mean follow-up of 10.7 years revealed only clinically non-relevant (∅ < 0.3 cm) neovascularizations in 1.5% of all treated legs. No clinical relevant varicosities from the groin had developed. The crossectomy combined with stump coagulation and suture of the fossa ovalis, completed with some additional measures, is a successful method to reduce neovascularization and recurrent varicosities, even for redo-crossectomies, without increasing the risk of perioperative complications.

Assessment of causes and patterns of recurrent varicose veins after surgery.

Background:Varicose vein surgery is characterized by high recurrence rate of 60% after 5 years of follow-up observation, and this is a disappointing finding, both for the patient and surgeon.Aim:To identify the possible causes and patterns of recurrent varicose veins.Materials and Methods:92 patients with recurrent varicose veins were enrolled in this study. Full detailed history, examination, and investigations were done.Results:30 patients had recurrence after saphenofemoral disconnection, 22 patients with recurrence after saphenofemoral disconnection and stripping below knee, 28 patients recurrence after saphenofemoral disconnection with stripping above knee and 12 patients recurrence after sapheno-popliteal disconnection with stripping. The double great saphenous veins, neovascularization and deep venous thrombosis before and after surgery were the most observed patterns of recurrence. The anatomical patterns of recurrence were more in leg then both leg and thigh pattern.Conclusion:Saphenofemoral ligation with below knee stripping has the least frequency of recurrence, while Trendlenberg operation alone has the highest.

PolytetraOuoroethylene patch saphenoplasty: Is it effective against recurrent varicose veins?

Background: Recurrent varicose veins after surgery (REVAS) are a common, complex and costly problem. The possibilities for recurrent varicose veins after correctly ligated SFJ may be due to: dilatation of preexisting venous tributaries from the common femoral vein (CFV) or formation of new veins as a result of angiogenic stimulation termed neovascularisation. Interposition of a prosthetic implant covering the saphenous stump has been called ''patch saphenoplasty. The aim of the present study is to evaluate the use of polytetrajluroethylene (PTFE) patch sutured over the saphenofemoraljunction (PTFE saphenoplasty) to reduce the incidence of recurrent varicose veins. Patients and methods: This study was conducted in General and Vascular Surgery Unit at Mansoura University hospital between March 2007 and November 2010.Patients were included ifthey had varicose veins from the CEAP clinical classification: C 2-5; recurrent varicose veins and isolated short saphenous vein varicosity were excluded. 320 patients (368 limbs) were eligible for the study; The patients were randomized into two groups; group L flush ligation of the GSV was performed at the SFJ without using any technique to contain possible postoperative neovasculorization; group IL underwent PTFE saphenoplasty (rectangular piece (2 x 3cm) of PTFE was sutured on the saphenous stump). Results: Both groups were comparable as regard patients' characteristics.The global incidence of early postoperative complications was higher in-group II than group I (9.4% vs. 3.8%) (PO.OOJ). Two months postoperative clinical and duplex examination revealed no clinical recurrence or neovascularization at the site of SFJ ligation in both groups.One-year postoperative clinical examination revealed recurrent thigh varicosities in 15/187 limbs in-group I (8 %) and in 8/181 limbs (4.4 %) in-group II. By duplex examination neovascularization occurred in 37/187 (19.7%) limbs in-group I (22 limbs grade 2 & 15 limbs grade 3) but in-group II neovascularization occurred in 19/181(10.5%) limbs (11 limbs grade 2 & 8 limbs grade). (P 0.001) Conclusion: Interposition of PTFE implant at the level of the ligated saphenofemoral stump significally reduces the incidences of clinical recurrence and neovascularization

Importance of Phasicity in Detection of Proximal Iliac Vein Thrombosis with Venous Duplex Examination

Superficial venous reflux is commonly the cause of symptomatic venous disease, but proximal venous obstruction may also play a role. A duplex ultrasound evaluating bilateral common femoral veins can detect differences in phasicity, which may be due to pelvic venous obstruction. We report a case of a patient with recurrent symptomatic varicose veins after treatment of superficial venous reflux. Based the duplex ultrasound results of damped respiratory phasicity, the patient was diagnosed with deep venous obstruction which was confirmed on MRV.

Reprinted Article “Prospective Randomised Study of Endovenous Radiofrequency Obliteration (Closure) Versus Ligation and Vein Stripping (EVOLVeS): Two-year Follow-up”

Purpose To study intermediate clinical outcomes, rates of recurrent varicosities and neovascularisation, ultrasound changes of the GSV, and the quality of life changes in patients from EVOLVeS trial. Methods Forty five patients were re-examined 1 year and 65 two years after treatment. Follow-up visits included clinical examination with CEAP classification and calculation of venous clinical severity score (VCSS), ultrasound examination, and a quality of life questionnaire. Results The clinical course of the disease (CEAP, VCSS) was similar in the two treatment groups. 51% of the GSV trunks occluded by RFO underwent progressive shrinkage with the external diameter decreased from 6.3 SD 1.4 mm at 72 h after treatment to 2.9 SD 1.5 mm at 2 years. An additional 41% of the GSV became undetectable by ultrasound at 2-year follow up. In two patients we observed re-opening of an initially closed GSV lumen. Neovascularisation was found in one RFO case and in four S and L cases. Cumulative rates of recurrent varicose veins at combined 1 and 2 years follow-up were 14% for RFO and 21% for S and L (NS). The difference in global QOL score in favour of RFO re-appeared at 1 year and remained significant at 2 years after treatment. Conclusion The 2-year clinical results of radiofrequency obliteration are at least equal to those after high ligation and stripping of the GSV. In the vast majority of RFO patients the GSV remained permanently closed, and underwent progressive shrinkage to eventual sonographic disappearance. Recurrence and neovascularisation rates were similar in the two groups although limited patient numbers prevent reliable statistical analysis. Improved quality of life scores persisted through the 2-year observations in the RFO group compared to the S and L group.

Reprinted Article “Neovascularisation is the Principal Cause of Varicose Vein Recurrence: Results of a Randomised Trial of Stripping the Long Saphenous Vein”

Objectives To determine whether routine stripping of the long saphenous vein reduces recurrence after varicose vein surgery. Design Randomised controlled trial. All operations done by a consultant vascular surgeon. Two year follow-up. Materials and methods One hundred patients with primary long saphenous varicose veins (133 legs) were randomised. Two year follow-up in 81 patients (113 legs) with questionnaire, clinical examination and Duplex scanning. Results Some 89% remained satisfied with the results of their surgery, though 35% had recurrent veins on clinical examination. Recurrence was reduced from 43 to 25% in patients who had their long saphenous vein stripped ( p = 0.04, χ 2). Neovascularisation (serpentine tributaries arising from the ligated saphenofemoral junction) was detected in 52% of limbs and was the commonest cause of recurrence. Most tributaries were less than 3 mm in diameter and only caused recurrence if the long saphenous vein or a major thigh vein was intact. Twelve patients had tributaries greater than 3 mm diameter and all had recurrent varicose veins. Conclusions Recurrence is common after varicose vein surgery and in this study was caused principally by neovascularisation at the ligated saphenofemoral junction. Clinical recurrence is reduced by routine stripping of the long saphenous vein.

Surgery for Recurrent Varicose Veins: Toward a Less-Invasive Approach?

Redo surgery for recurrent varicose veins, involving the saphenofemoral junction (SFJ) or saphenopopliteal junction has a bad reputation because it is a laborious, time-consuming intervention, characterized by a high incidence of postoperative complications. Moreover, outcome is worse than after primary surgery. This is illustrated by long-term (5 years) prospective follow-up of 235 reoperated limbs after redo procedure at the SFJ, all performed at the University Hospital of Antwerp between 1991 and 2009. Such invasive redo procedures will soon belong to the past because, nowadays, many less-invasive alternatives are available: phlebectomies without reopening the groin, focusing on the "varicose reservoir"; limited redo surgery with combined with foam sclerotherapy; endovenous ablation of a residual refluxing saphenous trunk; ultrasound-guided foam sclerotherapy; embolization treatment of pelvic vein incompetence; and treatment of an underlying deep-venous obstruction. All these interventions can be performed in an ambulatory setting, without need for general anesthesia.

Lower Limb Arterio-venous Fistula as a Late Complication of Phlebectomy in a Patient with Ehlers-Danlos Type IV

Ehlers-Danlos syndrome type IV (EDS type IV), the vascular type, results from mutations in the gene for type III procollagen ( COL3A1). Affected patients are at risk for arterial, bowel, and uterine rupture. The timing, frequency and course of these events are unpredictable. We report a 50-year-old patient with previous complications of EDS type IV who presented with recurrent varicose veins that subsequent imaging identified as an arteriovenous fistula (AVF) at the site of previous phlebectomy. Patients with EDS type IV present vascular surgeons manifold management problems. A pre-existing diagnosis of EDS type IV should alert the clinician to the risk of unusual presentations, both acutely and as complications subsequent to intervention. Once identified, appropriate investigation and follow-up of these patients by a vascular surgeon is mandated.

Neovascularisation after surgery for recurrent saphenofemoral incompetence: Does surgical dissection technique matter?

The effect of the type of surgery on neovascularisation in the groin is unknown. The aim of the present study was to compare three different surgical techniques used for recurrent saphenofemoral incompetence in view of their effect on neovascularisation in the groin at short- and long-term follow-up after surgery. 36 consecutive patients undergoing surgery for recurrent saphenofemoral incompetence were randomised. 12 patients underwent sharp dissection with knife or scissors and excision and ligation of scar tissue using absorbable suture material; 12 had dissection with electrocoagulation and 12 dissection with ultrasound (Ultracision Harmonic Scalpel). Clinical outcome was assessed using the venous clinical severity score and venous disability score, and the saphenofemoral junction was evaluated by means of duplex sonography three months and seven years after the operation respectively. If neovascularisation was present, the maximal diameter of new refluxing veins in the groin was measured. There was no statistically significant difference between the three surgical techniques. Duplex ultrasound showed neovascularisation with an average maximal diameter (± standard error) of the newly formed refluxing vessel of respectively 2.00 (± 0.63) mm, 1.00 (± 0.45) mm and 0.50 (± 0.50) mm after three months and 4.29 (± 1.41) mm, 3.32 (± 0.90) mm and 3.00 (0.83) mm after seven years (no significant difference between groups). After seven years no reflux was detected in 8/36 patients, no varicose veins were found in 14/36 patients. The patients were less symptomatic than before our redo operation and no one needed reoperation within the seven years. Dissection techniques in the groin did not influence the clinical and sonographic result at 3 months and at 7 years after redo surgery for recurrent varicose veins.

Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins

This report describes the clinical effectiveness and recurrence rates from a randomized trial of endovenous laser ablation (EVLA) and surgery for varicose veins. Some 280 patients were randomized equally using sealed opaque envelopes to two parallel groups: surgery and EVLA. Inclusion criteria included symptomatic disease secondary to primary, unilateral, isolated saphenofemoral junction incompetence, leading to reflux into the great saphenous vein (GSV). Outcomes were: technical success, recurrent varicose veins on clinical examination, patterns of reflux on duplex ultrasound examination, and the effect of recurrence on quality of life, assessed by the Aberdeen Varicose Vein Questionnaire (AVVQ). Assessments were at 1, 6, 12 and 52 weeks after the procedure. Initial technical success was greater following EVLA: 99.3 versus 92.4 per cent (P = 0.005). Surgical failures related mainly to an inability to strip the above-knee GSV. The clinical recurrence rate at 1 year was lower after EVLA: 4.0 versus 20.4 per cent (P < 0.001). The number of patients needed to treat with EVLA rather than surgery to avoid one recurrence at 1 year was 6.3 (95 per cent confidence interval 4.0 to 12.5). Twelve of 23 surgical recurrences were related to an incompetent below-knee GSV and ten to neovascularization. Of five recurrences after EVLA, two were related to neoreflux in the groin tributaries and one to recanalization. Clinical recurrence was associated with worse AVVQ scores (P < 0.001). EVLA treatment had lower rates of clinical recurrence than conventional surgery in the short term.

A comparative study between crepe bandage, tensopress, and panelast following varicose vein operations

This study was conducted in a district general hospital to compare the effect of three types of bandages applied following standard varicose vein operations. The three bandages studied were Crepe® bandage, Tensopress®, and Panelast®. The study included 60 patients and took place over a period of a year. All patients coming for a varicose veins operation were included in the study, including those with recurrent varicose veins. Patients were assessed before and after the operation and changes were recorded. The study showed that 91% of patients benefited from the operation, and their symptoms improved significantly. However, there was no significant difference among the different bandage groups with respect to the overall improvement in symptoms (p= 0.004) and cosmetic appearance (p = 0.005). Tensopress showed significant control of bleeding than did the other two bandages (p > 0.05), and Crepe bandage showed improvement in leg swelling (p > 0.05) and was more comfortable than the other two bandages (p = 0.1). There were no mortalities, and 91% of patients were treated satisfactorily as day surgery.

Technical procedure of two-port system subfascial endoscopic perforator vein surgery (TPS-SEPS)

It has long been noted that incompetent perforating veins contribute to the development of chronic venous insufficiency and recurrent varicose veins that are complicated by skin ulcerations or liposcleroderma. For these conditions, severing of incompetent perforating veins is an effective surgical treatment. However, severing of incompetent perforating veins by a direct approach has become less commonly performed because of the excessive invasiveness of the procedure itself. We referred to 37 cases (44 legs) of varicose veins with or without active venous dermatitis, who underwent the two-port system subfascial endoscopic perforator surgery, which we devised (hereafter referred to as TPS-SEPS). According to this method, incompetent perforating veins can be severed without surgical intervention in the lesion. The criteria for insufficiency of the perforating veins (IPVs) are reverse flow demonstrated on a color-flow duplex and a caliber more than 3 mm in diameter. One hundred forty one out of one hundred fifty two IPVs were processed. A mean of 3.21 perforating veins per patient was severed using ultrasonic coagulation-incision apparatus. From these 37 cases we conclude that TPS-SEPS provides a useful tool for the surgeon interested in treating severe chronic venous insufficiency same as the single-port technique. Our TPS-SEPS is a relatively simple operation, but its skill is dependable and provides lower invasiveness than other operation procedure. From now on, it is necessary to unify the authorized name of the endoscopic surgery of perforating veins and is also important to define the indication of this method for the primary varicose veins without stasisdermatitis.

Clinical Dynamics of Varicose Disease in Patients with High Degree of Venous Reflux During Conservative Treatment and After Surgery: 7-Year Follow-Up

183 patients (195 limbs) with primary femoral vein reflux were evaluated to relate valvular insufficiency and clinical results of elastic compression (68 limbs), saphenectomy (75 limbs), and valvuloplasty (52 limbs). Duplex scanning and calculating of Reflux Volume Index (RI) were performed before surgery and up to nine years of follow-up. Strong correlation between hemodynamic changes and results of treatment was found. Reulceration and recurrence were found in 74% of extremities with increasing leakage and in 14% of extremities with stable valve function. All 38 extremities with improved valvular function were free of ulcers and recurrent varicose veins. The success of surgical treatment in extremities with primary femoral vein reflux is associated with valvular function improvement. Elastic compression alone has poor clinical and hemodynamic results. Valvuloplasty significantly improves the results of surgical treatment.

Deficiencies in venous experience in UK vascular trainees: a survey of Rouleaux Club members

The aim of this study was to evaluate the training experience of current UK vascular trainees in the modern management of venous disease. A web-based questionnaire of the 145 members of the Rouleaux Club (www.rouleauxclub.com), which represents UK vascular trainees. Members were asked to complete the survey between June and October 2009 with regular email reminders being sent out to non-responders. One hundred and twenty-three trainees (85% response rate) representing all 17 UK training Deaneries responded. Seventy-eight per cent reported having received no formal venous duplex training either for diagnosis of venous disease or to guide endovenous therapy. Operative experience of great and small saphenous vein surgery improved with years of training. Surgical experience for recurrent varicose veins was poor. Experience with endovenous techniques was limited and variable. No experience of endovenous laser ablation or radiofrequency ablation was reported by 39% and 67% of trainees, respectively. Experience and/or training with foam sclerotherapy was limited to <40%. Many of those reporting no experience with endovenous ablation techniques were within the final two years of their training. Less than 25% of trainees reported having had any experience (assisted/performed) of advanced venous interventions such as thrombolysis techniques for deep venous thrombosis, inferior vena cava filter placement/removal, venous stenting or deep venous reconstruction. Less than a quarter of trainees are currently involved in the acute management of deep venous thrombosis. The majority (76%) of current trainees would like a formal approved UK venous training course to be offered. The current level of training in the management of venous disease will not allow UK vascular trainees to become the competent all round vascular specialists of the future.

Endovenous Laser Ablation (EVLA) to Treat Recurrent Varicose Veins

Objectives This cohort study assesses the effectiveness and safety of endovenous laser ablation (EVLA) in the management of recurrent varicose veins (RVVS). Method 104 limbs (95 patients) undergoing EVLA for RVVS were grouped according to pattern of reflux. For patients with recurrent SFJ/great saphenous vein (GSV) (Group GR) and SPJ/small saphenous vein (SSV) (Group SR) varicosities ablation rates and QoL (Aberdeen Varicose Vein Severity Scores (AVVSS)) were compared with those for age/sex matched patients undergoing EVLA for primary GSV/SSV dependent varicose veins (Groups GP and SP). Results In patients with RVVS the axial vein was ablated in 102/104 (98%) limbs whilst 2 GSVs (group GR) partially recanalised by 3 months (GSV ablated in 49/51 (96%) limbs versus 50/51 (98%) limbs in GP [ p = 0.2]). Improvements in AVVSS at 3 months (median GR: 14.2 (inter-quartile range (IQR) 10.2–18.9) to 3.2(1.2–6.4), p < 0.001; GP: median 15.9(IQR 11.4–22.7) to 3.8(1.1–5.6), p < 0.001, Mann–Whitney u-test) were similar (78% versus 76%, p = 0.23). The SSV was ablated in 24/24 limbs in groups SR and SP and the % improvement in AVVSS was 83% (median 14.4 (IQR 8.2–19.4) to 2.4 (1.9–4.6), p < 0.001, Mann–Whitney u-test) and 84% (median 13.8 (IQR 6.3–17.5) to 2.2 (1.2–5.1), p < 0.001) respectively ( p = 0.33). These improvements persisted at 1 year follow-up. A further 29 limbs with isolated anterior accessory great saphenous vein (AAGSV) or segmental GSV/SSV reflux were successfully ablated. Complication rates for primary and RVVS were similar. Conclusions EVLA is a safe and effective option for the treatment of RVVS and could be a preferred option for suitable patients.

Endovenous laser ablation of great saphenous veins using a 1470 nm diode laser and the radial fibre – follow-up after six months

Endovenous laser ablation (EVLA) is an efficient method to treat insufficient great saphenous veins (GSV) with high occlusion rates. Most studies used 810, 940 or 980 nm diode lasers and a bare fibre. Moderate postoperative pain and bruising are frequent findings. Laser systems with higher wavelengths like 1470 nm with a higher absorption in water show less pain and bruising after the procedure. A newly-developed fibre (radial fibre, Biolitec) emits the laser energy radially around the tip directly into the venous wall contrary to the bare fibre.(9) The aim of this study was to demonstrate the outcome and side-effects after EVLA of GSV with a 1470 nm diode laser (Ceralas E, Biolitec) by using the radial fibre. Non-randomized, prospective study including 50 unselected limbs of 50 patients with a duplex sonographically verified incompetent GSV. EVLA was performed with a 1470 nm diode laser (Ceralas E, Biolitec) and a radial fibre. In the same session all insufficient tributaries were treated by phlebectomy. Tumescent local anaesthesia with 0.05% lidocaine was applied perivenously. Laser treatment was carried out in a continuous mode with a power of 15 W. Compression stockings (30 mmHg) were applied for one month. Postinterventional checkups took place one, 10, 30 days and six months after the procedure. Three patients were lost to follow-up. The average linear endovenous energy density (LEED) was 90.8 J/cm vein (SD 35.3). At the six month follow-up all treated veins remained occluded and no new reflux in the treated segments occurred. No recurrent varicose veins had occurred so far. No severe complications such as deep venous thrombosis could be detected. In four patients at 30 days and three patients at six months local paresthesia occurred in the region of EVLA. Forty-four percent of patients did not have any pain after the treatment and 50% did not take any analgesic tablets at any time after the procedure. Postoperative ecchymoses in the track of the treated GSV was rare. In 80% of the limbs, no ecchymoses was observed after the treatment. EVLA of GSV with a radially emitting laser fibre by using a 1470 nm diode laser is a safe and efficient treatment option.