title: Implementation of endovenous laser ablation for varicose veins in a large community hospital: the first 400 procedures.
abstract: Endovenous laser ablation (ELA) has become a standard treatment of the incompetent great saphenous vein (GSV). Our prospective audit examines the implementation of this new method in a large community hospital with special attention to obstacles, technical results, pain scores, failures and our learning curve.
  
  
  METHODS
  Three hundred and twenty-three patients (403 limbs) with incompetence of the GSV underwent ELA. Patients were assessed by clinical examination and venous duplex ultrasound was performed 6 weeks after operation. Visual analog scale (VAS) pain scores of the first postoperative week were recorded. Operative time and success rate were analysed.
  
  
  RESULTS
  After 6 weeks, 301 (74.7%) treated legs were examined by duplex ultrasound imaging. Successful complete occlusion was present in 282 (93.7%) GSVs. Partial occlusion was present in 12 (4.0%) GSVs. In seven (2.3%) limbs the GSV was not occluded. The maximum mean VAS pain score was noted on the 5th postoperative day. From the start of this series, the operation time decreased rapidly for each surgeon, stabilising after 15 limbs.
  
  
  CONCLUSIONS
  ELA of the incompetent GSV is effective and safe. ELA is simple to perform, well accepted by patients and relatively atraumatic. In our opinion, ELA can be easily implemented in surgical practice.
authors.affiliation: Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands. j.bremer_van_den@lumc.nl
authors.forename: J
authors.initials: J
authors.lastname: van den Bremer
authors.forename: P Ph A Hedeman
authors.initials: PP
authors.lastname: Joosten
authors.forename: J F
authors.initials: JF
authors.lastname: Hamming
authors.forename: F L
authors.initials: FL
authors.lastname: Moll
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009426:Netherlands; D010147:Pain Measurement; D011446:Prospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult