title: Secondary ablation of saphenous veins: The reasons and the ratios.
abstract: OBJECTIVE
  To assess recurrence of saphenous veins and their tributaries following endovenous laser ablation (EVLA) and define primary or secondary ablation ratios as a result of misinterpretation, new incompetency formation, and re-canalization.
  
  
  METHODS
  The EVLA procedure was applied for vein insufficiency to 50 symptomatic patients (range, 22-78 years; mean age 45 ± 14 years; gender, 18 [36%] men, and 32 [64%] women). Before and after the procedure, a total of 80 legs were prospectively evaluated for recanalization of the great and small saphenous vein, anterolateral, posteromedial, intersaphenous thigh, and the calf veins by Doppler ultrasonography. EVLA was performed on the saphenous veins along with their tributaries, and was defined as the primary ablation. EVLA and alcohol ablation after the first procedure was defined as the secondary ablation. We evaluated the veins according to re-canalization and secondary ablation, and also measured the primary and secondary ablation ratios.
  
  
  RESULTS
  Seventy-three (97.0%) VSM and 39 (95.0%) VSP were treated with primary ablation and 2(3.0%) VSM and 2 (5.0%) VSP were treated with secondary ablation because of newly developed incompetency. In addition, 15 (71.0%) saphenous tributaries were treated with primary and 6 (29.0%) with secondary ablation. After primary or secondary ablation, 9 (12.0%) misinterpretation or new incompetency formation was found during a one-year follow-up. Seven (9.0%) VSM were re-canalized at the mean length of 46 ± 15 cm (range 32-65 cm) in one year. The laser energy in the re-canalized VSM was 78 ± 25 joules/cm (range 61-83) and all were retreated with laser or foam sclerotherapy.
  
  
  CONCLUSIONS
  VSM re-canalization and new vessel incompetency formation are reasons for secondary ablation, which is not a rare condition. Follow-up examinations and anatomical mapping are crucial for detecting new vessel formation or miss-interpretation after sclerotherapy or EVLA treatment.
authors.affiliation: Faculty of Medicine, Department of Radiology, Süleyman Demirel University, Isparta, Turkey aykutraktas@gmail.com.
authors.forename: Aykut Recep
authors.initials: AR
authors.lastname: Aktas
authors.affiliation: Faculty of Medicine, Department of Radiology, Baskent University, Adana, Turkey.
authors.forename: Ugur
authors.initials: U
authors.lastname: Ozkan
mesh_terms: D000328:Adult; D000368:Aged; D016342:Angioplasty, Laser; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery; D018608:Ultrasonography, Doppler; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Venous disease; endovenous laser treatment; re-vascularization; varicose veins; venous reflux