Mid-term results following endovenous laser ablation (EVLA) of saphenous veins with a 980 nm diode laser.
OBJECTIVE
To assess the mid-term results after endovenous laser ablation (EVLA) of saphenous veins by a standardized duplex and clinical protocol.


METHODS
A non-randomized prospective trial was performed. We included a total of 67 unselected legs of 65 patients with incompetent great or small saphenous veins (GSV and SSV), confirmed by duplex ultrasound. EVLA was carried out with a 980 nm diode laser in pulsed mode and using tumescent local anaesthesia. All patients were given heparin prophylaxis and compression therapy. Patients underwent standard clinical and duplex follow-up examinations with an average of 2.2 years (0.5-3.5 years) after EVLA.


RESULTS
Reflux was eliminated in 59 (88.1%) of the 67 treated veins after 2.2 (SD 0.9) years with an average energy density of 48 J/cm vein (19.8-96.1, SD 13.2). 11.9% of the cases demonstrated antegrade flow without reflux. In 8 of 67 treated legs (11.9%) reflux >0.5 s was still present. In these patients the initial vein diameter was significantly (P=0.01) higher than in the successfully treated limbs. Without reflux, the majority of treated veins, 41 of 59 (69.5%), were no longer detectable by ultrasound. In all groups with still visible veins, there was a diameter reduction of about 50%. Clinical classification (CEAP) and pitting edema similarly improved in all groups, and patient satisfaction was very high across the board. Recurrent varicose veins were significantly more frequent in the reflux group. Severe complications such as deep vein thrombosis or pulmonary embolism did not occur in any of the 67 treated cases.


CONCLUSIONS
EVLA of the GSV and SSV is a minimally invasive, safe and efficient treatment option with a high mid-term success rate. Not only standardized duplex, but also clinical criteria should be used in assessing the results.
Pannier
F
F
Dermatologie Kastanienhof, Köln, Germany. Felizitas.Pannier-Fischer@ukb.uni-bonn.de
Rabe
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D000925:Anticoagulants / Q000008:administration & dosage; D004487:Edema / Q000209:etiology / Q000601:surgery; D005260:Female; D005858:Germany; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation*; D054023:Lasers, Semiconductor; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012008:Recurrence; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D053828:Stockings, Compression; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
D000925:Anticoagulants; D006493:Heparin