title: Endovenous laser ablation and foam sclerotherapy for varicose veins: does the presence of perforating vein insufficiency affect the treatment outcome?
abstract: BACKGROUND
  Superficial venous insufficiency is a common problem associated with varicose veins. Endovenous laser ablation (EVLA) and concomitant ultrasound (US)-guided foam sclerotherapy are recent treatment methods alternative to surgery in the treatment of superficial venous insufficiency.
  
  
  OBJECTIVE
  To compare the effectiveness of EVLA and concomitant US-guided foam sclerotherapy prospectively in two different subgroups of the disease (isolated truncal vs. truncal with perforating vein insufficiency).
  
  
  METHODS
  The study was approved by the institutional review board. Fifty-five patients with symptomatic saphenous vein insufficiency and varicose veins were included in the study. Seventy-three EVLA and concomitant foam sclerotherapy were performed for 60 lower extremities. To determine the severity of the venous disease, Venous Clinical Severity Score (VCSS) and Visual Analogue Scale (VAS) were carried out before and 6 months after the treatment. Patients were followed up clinically and with Doppler ultrasonography for 6 months after the procedures.
  
  
  RESULTS
  At the sixth month of the follow-up; the total occlusion rate for the saphenous veins was 98.64% (72/73), and re-canalization rate was 1.36% (1/73). The total occlusion rate for the perforating veins was 75% (18/24), re-canalization rate was 25% (6/24). There was no notable major complication. VCSS and VAS scores were decreased significantly following the treatment (p < 0.05). The patients who had isolated saphenous vein insufficiency (Group I: 36/60) and those who had saphenous and perforating vein reflux (Group II: 24/60) were compared. VAS scores were more prominently decreased after the treatment in the isolated saphenous vein insufficiency group (p < 0.05). VCSS were also decreased more prominently in Group I when compared to Group II.
  
  
  CONCLUSIONS
  EVLA and concomitant US-guided foam sclerotherapy are effective, safe, and minimally invasive treatment options, yielding good cosmetic and clinical results in both isolated truncal and truncal with perforating vein insufficiency groups. However, clinical results and satisfaction of the patients were remarkably superior in cases with isolated truncal vein insufficiency compared to truncal and perforating vein insufficiency.
authors.affiliation: Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta, Turkey. mertkoroglu@hotmail.com
authors.forename: Mert
authors.initials: M
authors.lastname: Köroglu
authors.forename: Hüseyin Naim
authors.initials: HN
authors.lastname: Eris
authors.forename: Aykut Recep
authors.initials: AR
authors.lastname: Aktas
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kayan
authors.forename: Ahmet
authors.initials: A
authors.lastname: Yeşildağ
authors.forename: Meltem
authors.initials: M
authors.lastname: Cetin
authors.forename: Cem
authors.initials: C
authors.lastname: Parlak
authors.forename: Cemil
authors.initials: C
authors.lastname: Gürses
authors.forename: Okan
authors.initials: O
authors.lastname: Akhan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019233:Retreatment; D012501:Saphenous Vein; D015911:Sclerotherapy / Q000379:methods*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014648:Varicose Veins / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D014689:Venous Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*