Fate of the great saphenous vein following endovenous laser ablation: does re-canalisation mean recurrence?
OBJECTIVE
To assess changes in great saphenous vein (GSV) diameter and the significance of re-canalisation following endovenous laser ablation (EVLA).


METHODS
Prospective cohort study.


METHODS
Two groups were studied. Group A: 73 consecutive patients (84 GSVs) underwent EVLA followed by duplex ultrasound at 6, 12 and 52 weeks. Vein diameter and patency were recorded. Group B: From a prospectively maintained database 27 patients with a GSV that was found to have recanalised 6-12 weeks post-EVLA were identified and rescanned at 52 weeks. Pre- and post-treatment Aberdeen varicose vein severity scores (AVVSS) were measured.


RESULTS
Group A: 81/84 (96%) GSVs were ablated and 3/84 (4%) had re-canalised (flash reflux <1s). GSV diameter diminished with time: pre-EVLA: mean diameter 7.7 S.D .2.0mm; 6 weeks: 5.1 S.D. 1.3mm; 12 weeks: 3.2 S.D. 1.2; 52 weeks: 85% non-visible (p<0.001). Group B: 3/27 (11%) with reflux >1s underwent repeat EVLA. 16/27 (59%) remained competent at 52 weeks and 8/27 (30%) showed trickle reflux. Vein diameter decreased in both subgroups (mean diameter 7.3 S.D. 2.5mm to 3.1 S.D. 0.8mm (p=0.006) and 7.2 S.D. 2.3mm to 3.0 S.D. 0.7mm (p=0.009) respectively) as did the AVVSS (p<0.001).


CONCLUSIONS
Successful EVLA causes GSV shrinkage with transition from a non-compressible "thrombosed" vein to a non-visible vein by 1 year. A re-canalised GSV usually remains small with no/minimal reflux and persisting clinical benefit.
Theivacumar
N S
NS
The Leeds Vascular Institute, General Infirmary at Leeds, Leeds, UK. Electronic address: nadacumar@yahoo.co.uk.
Dellagrammaticas
D
D
The Leeds Vascular Institute, General Infirmary at Leeds, Leeds, UK.
Darwood
R J
RJ
The Leeds Vascular Institute, General Infirmary at Leeds, Leeds, UK.
Mavor
A I D
AID
The Leeds Vascular Institute, General Infirmary at Leeds, Leeds, UK.
Gough
M J
MJ
The Leeds Vascular Institute, General Infirmary at Leeds, Leeds, UK.
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D013997:Time Factors; D017211:Treatment Failure; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000601:surgery*