title: Six-year follow-up of endovenous laser ablation for great saphenous vein incompetence.
abstract: OBJECTIVE
  Treatment of chronic venous insufficiency of the great saphenous veins by endovenous laser ablation yields good short- and medium-term results, as assessed clinically and technically by echo-color-Doppler. At present, scarce data are available on the long-term results of endovenous laser ablation. We wanted to assess the long-term efficacy of endovenous laser ablation.
  
  
  METHODS
  We performed a prospective 6-year follow-up cohort study, with recruitment between 2003 and 2004, and the follow-up completed in 2010. The setting was an ambulatory care/day surgery. Of 209 consecutive patients who underwent endovenous laser ablation at our institution during the recruitment period, five (2.4%) did not complete the procedure due to technical reasons. Of 204 patients who successfully completed the intervention, 14 (6.8%) were lost for follow-up, and 190 completed the planned 6-year follow-up. The intervention was an endovenous laser ablation using a 980-nm laser diode. Clinical and echo-color-Doppler evaluations were regularly scheduled for all patients during the planned follow-up period. The incidence of clinical and echo-color-Doppler confirmed endovenous laser ablation failures over a 6-year follow-up period. Potential associations between failures and patients' characteristics, echo-color-Doppler findings, or surgical features were also investigated.
  
  
  RESULTS
  Symptomatic clinical endovenous laser ablation failures occurred in 22 (11.6%; 95% confidence interval [CI], 7.4-17.0%) patients; while 57 (30.0%; 95% CI, 23.6-37.1%) had echo-color-Doppler-confirmed failures. Only two patients (1.1%; 95% CI, 0.1%-3.8%) had both symptomatic clinical and echo-color-Doppler-confirmed failures. Three features of the great saphenous vein: an "atypical" junction, a junction diameter ≥8 mm, and a mean trunk diameter ≥8 mm, were independently associated with echo-color-Doppler-confirmed failures on multivariate logistic regression analysis.
  
  
  CONCLUSIONS
  Six years after endovenous laser ablation, most patients were improved on clinical grounds, and more than two-thirds had no saphenous insufficiency at echo-color-Doppler. Only a minority had both clinical and echo-color-Doppler-confirmed failures. Anatomical features of the junction and the saphenous diameter both at the junction and at the trunk independently predicted echo-color-Doppler-confirmed failures.
authors.affiliation: Centro Multidisciplinare di Day Surgery, Azienda Ospedaliera - Università, Padua, Italy. Electronic address: giorgio.spreafico@sanita.padova.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Spreafico
authors.affiliation: Centro Multidisciplinare di Day Surgery, Azienda Ospedaliera - Università, Padua, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Piccioli
authors.affiliation: Emergency Department, ULSS7, Pieve di Soligo, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Bernardi
authors.affiliation: Centro Multidisciplinare di Day Surgery, Azienda Ospedaliera - Università, Padua, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Giraldi
authors.affiliation: Centro Multidisciplinare di Day Surgery, Azienda Ospedaliera - Università, Padua, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pavei
authors.affiliation: Department of Statistics, University of Milano-Bicocca, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Borgoni
authors.affiliation: Centro Multidisciplinare di Day Surgery, Azienda Ospedaliera - Università, Padua, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ferrini
authors.affiliation: Centro Multidisciplinare di Day Surgery, Azienda Ospedaliera - Università, Padua, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Baccaglini