Favorable long-term results of endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber

• Published in: Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) NY), 2021-03, Vol.9 (2), p.352-360
• Main Authors: Pavei, Patrizia, Spreafico, Giorgio, Bernardi, Enrico, Giraldi, Enzo, Ferrini, Maurizio
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cross-Sectional Studies; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; EVLA; Female; Humans; Laser Therapy - adverse effects; Laser Therapy - instrumentation; Lasers, Semiconductor - adverse effects; Lasers, Semiconductor - therapeutic use; Long-term results; Male; Middle Aged; Postoperative Complications - etiology; Prospective Studies; Recurrence; Saphenous Vein - diagnostic imaging; Saphenous Vein - physiopathology; Saphenous Vein - surgery; Saphenous vein insufficiency; Time Factors; Treatment Outcome; Varicose Veins - diagnostic imaging; Varicose Veins - physiopathology; Varicose Veins - surgery; Venous Insufficiency - diagnostic imaging; Venous Insufficiency - physiopathology; Venous Insufficiency - surgery
• ISSN: 2213-333X; 2213-3348
• DOI: 10.1016/j.jvsv.2020.06.015

Scarce information is available on the long-term results of endovenous laser ablation (EVLA) for great saphenous vein (GSV) or small saphenous vein (SSV) insufficiency. We sought to provide data on the status of patients at least 9 years after EVLA. In 2018, we undertook a cross-sectional survey of ambulatory patients who had undergone EVLA in our tertiary care center in 2008-2009. Of 240 eligible patients, 5 died of causes not related to EVLA, 20 refused to participate, and 12 were lost to follow-up. Thus, 203 patients were re-evaluated; of them, 161 (79%) had GSV insufficiency and 42 (21%) had SSV insufficiency. The mean follow-up was 114 months (standard deviation, 11 months). All included patients underwent an echocardiography-color Doppler (ECD) evaluation, a clinical visit, and a standardized medical history. We assessed the competence of the junction and of the treated and untreated saphenous trunk and the presence of recurrent varicose veins. The trunk was considered ablated if it was nonvisible on B-mode or, when visible, if it was noncompressible or without flow or reflux on color flow Doppler analysis. Any recurrent varicose vein with the leakage point located in the treated saphenous vein was considered a failure. We asked patients about the effect of EVLA on their preoperative complaints and about any new or recurrent symptoms. We also recorded any complication or additional subsequent treatment and all data necessary to calculate the clinical class (C of the Clinical, Etiology, Anatomy, and Pathophysiology [CEAP] classification) and the Venous Clinical Severity Score (VCSS). Finally, we investigated potential associations between the study outcomes and variables by multiple logistic regression techniques. Some 10 years after EVLA, we performed a single clinical and ECD evaluation in 203 patients. Only one recanalization (0.5%; 95% confidence interval, 0.0-2.7) of the treated GSV trunk was observed in an otherwise asymptomatic patient. Up to 98% of patients were asymptomatic or significantly improved after EVLA. Additional subsequent treatments occurred in 21% of patients with GSV insufficiency and 5% of patients with SSV insufficiency. Three complications were observed, two in the GSV group (varicophlebitis, saphenous nerve damage) and one (varicophlebitis) in the SSV group. The mean C class of CEAP and the mean VCSS were significantly lower at the end of follow-up, both in patients with GSV insufficiency (C class, 3.2 vs 1.5 [P = .00001]; VC