title: Combined endovenous laser therapy and pinhole high ligation in the treatment of symptomatic great saphenous varicose veins.
abstract: BACKGROUND
  The aim of this study was to determine the effectiveness and short-term outcomes of endovenous laser therapy (EVLT) combined with pinhole high ligation (PHL) in the treatment of great saphenous varicose veins.
  
  
  METHODS
  From February 2011 to May 2012, 200 patients with great saphenous varicose veins were treated using combined EVLT and PHL. Sixty-eight of them had concurrent TriVex suction. There were 118 men and 82 women with a median age of 61 (range 28-82) years. All patients had more than one of the following presentations, including lower extremity heaviness, pain, edema, varicose vein, skin changes, or ulceration. Based on the CEAP clinical classification, 20 patients had C2, 85 had C3, 48 had C4, 23 had C5, and 24 had C6 chronic venous disease. Ninety patients had VV involving the left lower extremity, 56 involving the right lower extremity, and 54 involving the bilateral lower extremities. Duplex ultrasound (US) was performed for all the 200 patients, and showed great saphenous valve dysfunction and reflux in 148 patients. Fifty-two of the 200 patients had concurrent mild femoral vein reflux. Deep venous thrombosis (DVT) was ruled out in all the patients.
  
  
  RESULTS
  Technical success rate of PHL and laser ablation was 100%. Median follow-up was 9 months, ranging from 3 to 20 months. Symptoms were resolved or significantly improved in all patients after surgery. The ulcers healed in 23 of the 24 patients (96%) within 3 months. Ten patients developed subcutaneous hematoma, and 8 had slightly worsening edema. Ten patients with complications of numbness due to saphenous nerve burning injury were treated with mecobalamin, and the numbness sensation improved within 1 month and disappeared within 3 months. Nine patients sustained saphenous vein thrombophlebitis postoperatively and were treated with ibuprofen and a heating pad. There was no recanalization of the great saphenous vein, deep venous thrombosis (DVT), or deaths in this group of patients.
  
  
  CONCLUSIONS
  Combined EVLT and PHL are less invasive and are effective in the treatment of symptomatic great saphenous varicose veins. PHL prevents DVT, and significantly decreases recanalization of the great saphenous vein after endovenous laser ablation. Short-term outcomes have been satisfactory, but long-term follow-up is needed.
authors.affiliation: Department of Vascular Surgery, Yinzhou Hospital of Ningbo University, Ningbo, Zhejiang, China. Electronic address: drzhuhuipeng@yahoo.cn.
authors.forename: Hui-peng
authors.initials: HP
authors.lastname: Zhu
authors.affiliation: Department of Vascular Surgery, Yinzhou Hospital of Ningbo University, Ningbo, Zhejiang, China.
authors.forename: Yi-lin
authors.initials: YL
authors.lastname: Zhou
authors.affiliation: Department of Vascular Surgery, Yinzhou Hospital of Ningbo University, Ningbo, Zhejiang, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Vascular Surgery, Yinzhou Hospital of Ningbo University, Ningbo, Zhejiang, China.
authors.forename: Jin-lin
authors.initials: JL
authors.lastname: Yan
authors.affiliation: Department of Vascular Surgery, Yinzhou Hospital of Ningbo University, Ningbo, Zhejiang, China.
authors.forename: Zhong-you
authors.initials: ZY
authors.lastname: Xu
authors.affiliation: Department of Vascular Surgery, Yinzhou Hospital of Ningbo University, Ningbo, Zhejiang, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Vascular Surgery, Yinzhou Hospital of Ningbo University, Ningbo, Zhejiang, China.
authors.forename: Qing-ming
authors.initials: QM
authors.lastname: Zhao
authors.affiliation: Department of Vascular Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Zai-ping
authors.initials: ZP
authors.lastname: Jing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000175:diagnosis / Q000601:surgery*; D014945:Wound Healing