Endovenous laser treatment of the small saphenous vein

Dimitrios Kontothanassis, Roberto Di Mitri, Salvatore Ferrari Ruffino, Eleonora Zambrini, Giuseppe Camporese, Jean Luc Gerard, Nicos Labropoulos
Journal of Vascular Surgery 2009, 49 (4): 973-979.e1

PURPOSE: Endovenous laser treatment is a minimally invasive technique for ablation of the incompetent great (GSV) and small saphenous vein (SSV). Compared with the GSV, fewer data are available on SSV laser ablation and are not validated. This multicenter prospective study evaluated the feasibility, safety, and efficacy of endovenous laser ablation to treat SSVs.

METHODS: Between January 2003 and January 2007, 204 patients (229 limbs) with CVD and incompetent SSVs (evaluated by the CEAP classification) who were eligible for surgery underwent consecutive laser ablation procedures. Many required additional treatment for varicose tributaries and perforator veins with phlebectomy and foam sclerotherapy, Energy was delivered to the vein wall by a 600-microm optical fiber using 810-nm or 980-nm diode laser. Ablations were performed with duplex ultrasound (DU) guidance and tumescent anesthesia. Follow-up was with clinical examination and DU imaging.

RESULTS: DU imaging showed immediate occlusion of the SSV with no thrombosis in the proximal veins. No complications occurred intraoperatively. All patients had postoperative ecchymosis, but it was minimal. Three patients had distal thrombotic complications. Superficial phlebitis after complementary surgery occurred in three cases. Complete occlusion with absence of flow </=2 months of follow-up was detected in 226 SSV (98.7%). It occurred 22 in patients with large SSV diameter. Recanalization was found in one patient at 12 months and in two patients at 24 months. Seven limbs had reflux in previously treated areas, treated segments, and segments in continuity with them. Three underwent an intervention to correct symptomatic reflux. The other four had no symptoms. After 1 year, eight limbs developed reflux in new locations and four underwent treatment. Symptoms resolved in most patients soon after the operation. The mean follow-up was 16 months (range, 2-39 months). After 8 to 12 months postprocedurally, the laser-treated veins were fibrotic and almost indistinguishable on DU imaging from the surrounding tissues. In five patients (2.25%) postoperative paresthesia occurred >2 to 3 days postoperatively and persisted in the follow-up. No paresthesia occurred in our last series whenever a larger amount of tumescent cold saline was infused around the vein.

CONCLUSION: Endovenous laser ablation of the SSV has excellent early and midterm results. The prevalence of thrombosis and paresthesia is very low. Symptom relief is very good.

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