Laser-sclerosing foam hybrid treatment, a non-tumescent technique for insufficient great saphenous vein ablation.

OBJECTIVE: We aim to report on the Laser-Sclerosing Foam Hybrid Treatment (LSFHT) and its outcomes when used on patients with great saphenous vein (GSV) insufficiency. METHODS: This was a single center retrospective cohort study on patients with GSV insufficiency that were treated with the LSFHT technique, a surgical procedure that comprises the use of both sclerosing foam and endovenous ablation and avoids the use of tumescent anesthesia. Occlusion rates and complications were reported. RESULTS: 139 legs from 106 patients were operated, achieving a 100% occlusion rate, while only a small burn and 2 popliteal vein thrombosis cases occurred. CONCLUSION: The study suggests that the LSFHT is a feasible fast procedure that proved both effective and safe for the treatment of GSV insufficiency.

Endovenous laser treatment vs conventional surgery for great saphenous vein varicosities: A propensity score matching analysis.

BACKGROUND: Varicosis is a common venous condition, which is typically treated surgically. However, selection of the optimal surgical approach can be challenging. Previous studies comparing endovenous laser treatment (EVLT) and conventional surgery were retrospective and observational in nature and the results may therefore have been influenced by selection bias and the presence of other confounding factors. In this study, we used propensity score matching to reduce selection bias when comparing EVLT and conventional surgery for the treatment of varicose great saphenous veins. AIM: To compare the perioperative and postoperative outcomes of EVLT and conventional surgery in patients with great saphenous vein varicosis. METHODS: We retrospectively reviewed the records of 1063 patients treated for primary varicosis of the great saphenous vein at the Second Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2019. Among them, 56 patients were excluded owing to additional small saphenous varicose vein involvement, 81 owing to recurring varicose veins, 83 owing to complicated varicose veins (CEAP clinical classification C5-C6), and 6 owing to perioperative phlebitis. Finally, 772 patients were enrolled in this study. Standard demographic and clinicopathological data were collected from the medical records of the patients. For propensity score matching, 522 patients (261 who underwent EVLT and 261 who underwent conventional surgery) were randomly matched 1:1 by age, sex, onset time, smoking status, presence of diabetes, family history, stress therapy, C class, and the affected leg. RESULTS: Of the 772 patients included in the study, 467 underwent EVLT and 305 underwent conventional surgery. There were significant differences in age, onset time, smoking and diabetes status, and family history between the two groups. Following propensity score matching, no significant differences in patients' characteristics remained between the two groups. ELVT was associated with a shorter operation time and hospital stay than conventional surgery, both before and after propensity score matching. There were no differences in complications between the two groups after propensity score matching. Patients who underwent EVLT had a higher recurrence rate during the two-year follow-up period than those who underwent conventional surgery (33.33% vs 21.46%, χ2 = 11.506, P = 0.001), and a greater percentage of patients who underwent EVLT experienced pain one week after the procedure (39.85% vs 19.54%, P = 0.000). CONCLUSION: EVLT may not always be the best option for the treatment of great saphenous vein varicosis.

Treatment of venous malformations with tumescent-assisted sclero-embolic and ablative lasers (SEALs): Safe and effective long-term outcomes.

BACKGROUND: Perivascular infiltration of tumescent anaesthesia (TA) is an essential element of endovenous thermal ablative procedures employed to treat superficial venous disease. In addition to anaesthesia, TA is administered to achieve vessel wall approximation and to protect surrounding structures from thermal damage. However, its role in the treatment of venous malformations (VMs) has not been established. OBJECTIVES: To assess the safety and efficacy of tumescent-assisted thermal and chemical ablative methods in the treatment of VMs. METHODS: Adult and paediatric patients presenting with VMs were treated using a combination of endovenous laser ablation, foam embolo-sclerotherapy and liquid embolisation using n-BCA. All procedures were ultrasound-guided. Treatment outcomes were assessed in early and late follow-ups. To assess the efficacy of TA in achieving vessel wall approximation, cross-sectional lesional diameters were measured by ultrasound, before and after the administration of TA during endovenous procedures. RESULTS: In a 12 month period, 22 patients recruited in the study presented with 27 VMs which included 23 extra-truncular lesions (16 subcutaneous and seven intramuscular) and four truncular anomalies. On average the subcutaneous lesions measured 5.5 mm (1.9-24.5 mm) in diameter, intramuscular lesions measured 9.2 mm (5.9-15.1 mm) and truncular anomalies measured 4.9 mm (1.2-12 mm) in diameter. Perivascular infiltration of TA resulted in a significant reduction in vessel calibre (90% reduction on average). Intramuscular VMs were less compressible with TA (69.2% reduction) compared to subcutaneous lesions (98% reduction). Truncular anomalies such as the embryonic marginal vein achieved complete approximation (100% reduction). Procedures were safely tolerated with no major complications such as thromboembolism, stroke, nerve damage or tissue necrosis. Most patients had significant clinical as well as ultrasonographic improvement. CONCLUSION: Tumescent-assisted endovenous laser ablation and foam sclerotherapy provides safe and effective outcomes in patients with a variety of VMs.

Outcomes of endovenous laser ablation with additional iliac vein stenting of nonthrombotic lesions in patients presenting with active venous ulcers.

OBJECTIVE: We evaluated the clinical outcomes of superficial and perforator ablation and the effects on wound healing by adding iliac vein stenting of nonthrombotic iliac vein lesions (NIVLs) in patients presenting with active venous ulcers. METHODS: A retrospective analysis was performed of patients who had presented with venous ulcers and had a diagnosis of NIVLs from January 2017 to December 2019. Patients with a >50% diameter reduction in the iliac vein as determined by computed tomography venography had undergone transfemoral venography for further confirmation. Patients were divided into the endovenous laser ablation (EVLA) group and EVLA with stenting (EVLAS) group. The EVLA group had undergone endovascular laser treatment of superficial venous reflux, and the EVLAS group had undergone EVLA and stenting for NIVLs. The clinical outcomes were compared between the two groups. The primary end point was cumulative ulcer healing at 12 months. The secondary end points included complications, venous clinical severity score improvements, and pain scores during the follow-up period. Univariable and multivariable regression models were used to determine the refractory ulcer predictors. RESULTS: A total of 157 patients were included, 93 in the EVLAS group and 64 in the EVLA group. Of the 93 patients in the EVLAS group and patients in the EVLA group, 30 (32.26%) and 17 (26.56%) had presented with iliac venous occlusion, respectively (P = .48). The mean percentage of stenosis was 78.0% ± 13.6% in EVLAS group and 77.0% ± 14.0% in the EVLA group (P = .36). No significant differences in the general preoperative data were observed between the two groups. Cumulative ulcer healing at 1 year was 86.8% and 65.6% in the EVLAS and EVLA groups, respectively (P = .001). After a mean follow-up of 22 months (median, 24 months), the EVLAS group had a significantly improved venous clinical severity score compared with the EVLA group (EVLAS group, 8.3; EVLA group, 11.7; P = .01). Multivariable analysis of the entire cohort showed that obesity and employment that requires standing were predictive of refractory ulcers and that iliac venous stent placement was a protective factor for ulcer healing. CONCLUSIONS: The results of the present study have suggested an association between improvement in the overall success of venous leg ulcer healing when including treatment of NIVLs with stents into a treatment plan that already includes saphenous and perforator vein ablation.

Midterm varicose vein recurrence rates after endovenous laser ablation: comparison of radial fibre and bare fibre tips.

OBJECTIVES: We evaluated and compared midterm recurrence results of our patients with great saphenous vein insufficiency who were treated with a 1470-nm diode laser using 2 different types of fibre catheter kits. METHODS: A total of 61 consecutive patients were treated between 2013 and 2014 with a bare fibre (BF) tip (BF group) and 60 consecutive patients were treated with a radial fibre (RF) tip (RF group) from 2014 to 2016. First-year venous clinical severity scores (VCSSs) were compared with VCSS before endovenous laser ablation and at the first-month follow-up. Patients were examined for recurrence and classified according to the system developed by Stonebridge. RESULTS: There was no significant difference between the 2 groups in terms of VCSS. Examination with Doppler ultrasonography showed no recurrence in the RF group, whereas recurrences were detected in 6 patients in the BF group, which was statistically significant (P = 0.028). All of the recurrences were type 1b (incompetent tributaries) varicose vein recurrences. The VCSS of the patients with recurrence were the same as the scores of patients without recurrence (0.5 ± 0.55). CONCLUSIONS: Varicose vein recurrence was more often seen in the BF group than in the RF group. Recanalization-induced and neovascularization-induced recurrences were not found in either group. Saphenofemoral side branch-induced recurrence was more significant in the group treated with the BF tip.

Endovenous laser ablation: A comprehensive review.

OBJECTIVE: To provide an evidence-based overview of endovenous laser ablation and describe its role as an effective and durable technique for the management of superficial venous insufficiency. METHODS: The published literature on the treatment of varicose veins using endovenous laser ablation was reviewed. The literature search focused on the history of endovenous laser ablation, its safety and durability, known complications, and differences in outcomes based on the iterations of fiber type and laser wavelength. RESULTS: Treatment safety and efficacy of endovenous laser ablation appear to be based on the amount of energy administered over a defined distance, or the linear endovenous energy density. The ideal linear endovenous energy density varies with the laser wavelength and fiber-type. Post-operative pain and bruising may be reduced by the use of higher wavelength fibers or the use of radial or jacket-tip fibers as compared to bare-tip fibers. The incidence of endothermal heat-induced thrombosis remains low and has declined with increasing experience. Reports have demonstrated a greater than 90% technical success rate with saphenous endovenous laser ablation, long-term durability of ablation, and commensurate improvement in quality of life. CONCLUSIONS: Endovenous laser ablation is a safe and durable treatment option for the management of incompetent superficial and perforator veins of the lower extremities. As an endothermal technology, it remains a key component of the standard of care for the treatment of chronic venous insufficiency.

Pain in the aftermath of minimal invasive treatment for unilateral incompetence of the great saphenous vein.

OBJECTIVES: Assessment of postprocedural pain after minimal invasive treatment of unilateral incompetence of the great saphenous vein. METHODS: A total of 85 patients treated with endovenous laser ablation (1470 nm) in combination with foam sclerotherapy and evulsions reported postprocedural pain on a visual analogue scale (0-10) during 28 days after treatment. RESULTS: A mean pain reduction from 3.9 on the first postinterventional day to 0.3 was noted during the observation time. After 28 days, 7% of patients had a visual analogue scale >1. Higher body mass index was strongly associated with more pain during the whole follow-up period (p < 0.01). Higher energy application per cm vein and greater great saphenous vein diameter showed more pain in the first week. Other factors like clinical stage CEAP classification, combination of laser with avulsions and/or sclerotherapy, season of treatment timepoint, and age or sex did not influence postinterventional pain course. CONCLUSION: Higher body mass index and higher energy application per cm are associated with more postprocedural pain after endovenous laser ablation.

Effectiveness of iliac vein stenting combined with high ligation/endovenous laser treatment of the great saphenous veins in patients with Clinical, Etiology, Anatomy, Pathophysiology class 4 to 6 chronic venous disease.

BACKGROUND: Lower limb chronic venous disease (CVD), resulting from iliac vein compression syndrome (IVCS), manifests as a series of symptoms ranging from varicose veins to venous ulcerations. Stent implantation has been considered an effective treatment method; however, the management of CVD has rarely been reported. In the present study, we evaluated the treatment and outcomes of patients with CVD. METHODS: We performed a retrospective cohort study of patients with severe iliac vein stenosis with lower limb CVD. The patients were divided into two groups: group 1 had received stenting alone (n = 42), and group 2 had received stenting and high ligation/endovenous laser treatment (n = 29). We evaluated the clinical outcomes using the Venous Clinical Severity Score and visual analog scale, and assessed the quality of life (QoL) using the Chronic Venous Disease QoL questionnaire at a median follow-up point of 15 months (range, 6-25 months). RESULTS: In our cohort, the prevalence rate of nonthrombotic IVCS (NIVCS) was 11.7% (98 of 838 patients). The technical success rate was 100%, without severe complications. During the study period, three group 1 patients and two group 2 patients were lost to follow-up. The overall patency rate in the patients with NIVCS during a mean follow-up period of 15.0 months (range, 6-25 months) was 94.4%. For patients with a Clinical, Etiology, Anatomy, Pathophysiology (CEAP) clinical class of <4, all parameters showed similar improvements in the two groups, except for the disappearance of varicose veins. However, in patients with a CEAP clinical class of ≥4, the combination therapy significantly improved their QoL. The Venous Clinical Severity Score reduction was 4.64 ± 1.72 in group 1 and 11.89 ± 1.82 in group 2 (P < .01). Pain, scored using the visual analog scale, demonstrated a decrease from 4.41 to 2.52 (P < .05) in group 1 and 4.71 to 0.53 (P < .01) in group 2. The relief rate of stasis dermatitis in groups 1 and 2 was 26.9% and 90.5%, respectively (P < .05), and the venous ulceration healing rate was 16.7% and 87.5%, respectively (P < .05). CONCLUSIONS: The prevalence of NIVCS should not be overlooked. The proposed combination treatment is an effective therapeutic strategy for patients with NIVCS and advanced CVD (CEAP clinical class, ≥4) during short-term follow-up.

Comparison of endovenous laser treatment and high ligation in treatment of limb varicosity: A meta-analysis.

To assess the efficacy and safety of endovenous laser treatment (EVLT) and high ligation (HL) for limb varicosity using meta-analysis. Multiple databases including PubMed, Springer, Excerpta Medica Database, Ovid Technologies, and China Journal Full-text database were searched for relevant studies in English or Chinese, and full-text articles were used to compare EVLT and HL for limb varicosity. Review Manager 5.0 was used to estimate the effects of the results among eligible articles. Forest plots, sensitivity analysis, and bias analysis of the included articles were also conducted. Initial screening yielded 1031 studies, 11 randomised controlled trials involving 1145 limb varicosity patients met the inclusion criteria in this study. The results of the heterogeneity test suggested that intraoperative blood loss mean difference (MD) = -6.31[-9.03, -3.60], P < 0.00001), operative time (MD) = -39.76[-42.27, -37.24], P < 0.00001), rate of complications (odds ratio [OR] = 0.37[0.22, 0.61], P < 0.0001), and recurrence (OR = 0.28[0.16, 0.49], P < 0.0001) were significantly different. Although both EVLT and HL have their own merits and demerits, EVLT is a more effective and safe method to treat limb varicosity.

Initial outcomes of endovenous laser ablation with 1940 nm diode laser in the treatment of incompetent saphenous veins.

OBJECTIVES: To investigate the initial outcomes of 1940 nm diode laser in the treatment of incompetent saphenous veins. METHODS: This was a prospective observational study. We treated 89 patients with 160 incompetent saphenous veins using a 1940 nm diode laser and bare fiber. The laser's power was set to 4.5 W with a mean linear endovenous energy density of 50.4 J/cm. RESULTS: The one-month closure rate was 100%. The post-procedural pain score at 6 h, 1 day, 10 days, and 1 month was 0.85 ± 1.04, 0.65 ± 1.01, 0.82 ± 1.25, and 0.47 ± 0.82, respectively. Complications encountered included paresthesia (3.8%) and thrombophlebitis (4.4%), whereas no cases of endovenous heat-induced thrombosis were observed. CONCLUSION: The 1940 nm laser and bare fiber at 50.4 J/cm showed satisfactory initial outcomes with less pain and fewer complications, in the treatment of incompetent saphenous veins.

Histological and Immunofluorescent Analysis of a Large Tributary of the Great Saphenous Vein Treated with a 1920 nm Endovenous Laser: Preliminary Findings.

OBJECTIVES: To analyse the biological effects of a 1920 nm endovenous laser (EVL) on extra-fascial great saphenous vein (GSV) in vitro. METHODS: A 10 cm length of a large tributary bypassing a hypoplastic segment of the GSV (sometimes called an "extra-fascial GSV") was obtained during routine varicose vein surgery. The length was treated in five sections with different LEEDs (0 (control), 20, 40, 60, and 80 J/cm) with a 1920 nm EVL at 4W power, in a novel in vitro treatment model. The biological effects were assessed by histological staining of the samples for haematoxylin and eosin (HE) and Martius Scarlet Blue (MSB), and by immunofluorescent detection of p-p53 and VCAM-1. RESULTS: Histological analysis showed significant structural damage at LEEDs above 60 J/cm, especially in the intima and media, with the treatment at 80 J/cm causing perforation of the vein wall. In addition, there was a significant increase in p-p53 expression in treated tissue at 60 and 80 J/cm. CONCLUSIONS: Using this ex vivo model, the results indicate that in vitro treatment with a 1920 nm EVL, at or above an LEED of 60 J/cm and 4 W power, causes significant vein wall cell death reaching deep into the media by a combination of direct thermal damage and apoptosis. A wavelength of 1920 nm appears to be effective for the endovenous ablation of truncal veins.

Foaming of blood in endovenous laser treatment.

This work is dedicated to a challenging issue of modern phlebology-establishment of a physical mechanism of the endovenous laser treatment (EVLT) against great saphenous vein incompetence (protuberant varicosities). Using optical and acoustical methods, we have studied the laser-induced formation of microbubbles in an aqueous solution of surface-active substances, serum, and blood directly in patients while conducting EVLT of the great saphenous vein in a clinical setting. We have used lasers with wavelengths 0.97 and 1.47 µm. Their radiation was transmitted through a quartz-quartz polymer fiber 600 µm in diameter. It has been found that in all cases, the laser beam with moderate power (1-10 W) supplied through an optical fiber leads to the formation of micro-bubbled foam. It has been shown that laser exposure during EVLT induces blood boiling, which results in heating of the venous walls (thermal destruction of the intima) and provides effective foam occlusion of the blood vessels (hemostasis). Necessary and sufficient conditions for a successful EVLT are associated with the thermal destruction of intima and laser-induced foam hemostasis.

A 1470-nm laser combined with foam sclerotherapy in day surgery: a better choice for lower limb varicose veins.

Day surgery is being more and more adopted by clinicians. Higher wavelength lasers give patients better experience than lower wavelength lasers, which makes it more suitable for day surgery. This study compares the short- and mid-term efficacy, postoperative morbidity, and patient satisfaction of "1470-nm endovenous laser ablation (EVLA) combining foam sclerotherapy in day surgery" with "810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery" on great saphenous vein (GSV) insufficiency postoperatively. A single-institution historical cohort study of 194 patients was performed in Shanghai Ninth People's Hospital, China. Ninety-seven patients received 1470-nm EVLA combining foam sclerotherapy in day surgery ("1470-nm group"), and 97 patients received 810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery recommended by guidelines ("810-nm group"). No significant difference was found between the 1470-nm group and the 810-nm group in terms of GSV occlusion rate (both 100%), complication rate, and recurrence rate (8.2 vs. 11.3%) during the period of 1-12 months after surgery. Serious complications in the 1470-nm group and 810-nm group were 0 and 1.0%. Minor complications in the 1470-nm group and 810-nm group were ecchymosis at 20.6 and 18.6%, edema at 69.1 and 63.9%, and paresthesia around ankle at 0 and 3.1%, respectively. Advantage of the 1470-nm group over the 810-nm group was statistically significant considering the patient perioperative comfort and economic cost. Treatment of 1470-nm EVLA combining foam sclerotherapy in day surgery has similar efficacy as the 810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery in GSV insufficiency and is more comfortable with less incision, hospitalization procedure, and medical costs. It may be a new option for patients who are afraid or unable to be hospitalized.

A randomized prospective long-term (>1 year) clinical trial comparing the efficacy and safety of radiofrequency ablation to 980 nm laser ablation of the great saphenous vein.

Purpose To compare the short- and long-term (>1 year) efficacy and safety of radiofrequency ablation (ClosureFAST™) versus endovenous laser ablation (980 nm diode laser) for the treatment of superficial venous insufficiency of the great saphenous vein. Materials and methods Two hundred patients with superficial venous insufficiency of the great saphenous vein were randomized to receive either radiofrequency ablation or endovenous laser ablation (and simultaneous adjunctive therapies for surface varicosities when appropriate). Post-treatment sonographic and clinical assessment was conducted at one week, six weeks, and six months for closure, complications, and patient satisfaction. Clinical assessment of each patient was conducted at one year and then at yearly intervals for patient satisfaction. Results Post-procedure pain ( p < 0.0001) and objective post-procedure bruising ( p = 0.0114) were significantly lower in the radiofrequency ablation group. Improvements in venous clinical severity score were noted through six months in both groups (endovenous laser ablation 6.6 to 1; radiofrequency ablation 6.2 to 1) with no significant difference in venous clinical severity score ( p = 0.4066) or measured adverse effects; 89 endovenous laser ablation and 87 radiofrequency patients were interviewed at least 12 months out with a mean long-term follow-up of 44 and 42 months ( p = 0.1096), respectively. There were four treatment failures in each group, and every case was correctable with further treatment. Overall, there were no significant differences with regard to patient satisfaction between radiofrequency ablation and endovenous laser ablation ( p = 0.3009). There were no cases of deep venous thrombosis in either group at any time during this study. Conclusions Radiofrequency ablation and endovenous laser ablation are highly effective and safe from both anatomic and clinical standpoints over a multi-year period and neither modality achieved superiority over the other.

Defining the optimum tumescent anaesthesia solution in endovenous laser ablation.

Objectives To produce a tumescent anaesthesia solution with physiological pH for endovenous thermal ablation and evaluate its influence on peri- and postoperative pain, clinical and quality of life outcomes, and technical success. Methods Tumescent anaesthetic solution (0.1% lidocaine with 1:2,000,000 epinephrine) was titrated to physiological pH by buffering with 2 ml incremental aliquots of 8.4% sodium bicarbonate. Patients undergoing great saphenous vein endovenous laser ablation and ambulatory phlebectomy were studied before and after introduction of buffered tumescent anaesthetic. Primary outcome was perioperative pain measured on a 10 cm visual analogue scale. Secondary outcomes were daily pain scores during the first postoperative week, complications, time to return to normal activity, patient satisfaction, generic and disease-specific quality of life, and technical success. Patients were assessed at baseline, and at 1, 6 and 12 weeks following the procedure. Results A physiological pH was achieved with the addition of 10 ml of 8.4% sodium bicarbonate to 1 l of standard tumescent anaesthetic solution. Sixty-two patients undergoing great saphenous vein endovenous laser ablation with phlebectomy were recruited before and after the introduction of buffered tumescent anaesthetic solution. Baseline and operative characteristics were well matched. The buffered solution was associated with significantly lower (median (interquartile range)) periprocedural pain scores (1 (0.25-2.25) versus 4 (3-6), p < 0.001) and postoperative pain score at the end of the treatment day (1.8 (0.3-2.8) versus 3.0 (1.2-5.2), p = 0.033). There were no significant differences in postoperative pain scores between the groups at any other time. There were no significant differences in other clinical outcomes between the groups. Both groups demonstrated significant improvements in generic and disease-specific quality of life, with no intergroup differences. Both groups demonstrated 100% ultrasonographic technical success at all time points. Conclusions Buffering of tumescent anaesthetic solution during endovenous thermal ablation is a simple, safe, inexpensive and effective means of reducing perioperative and early postoperative pain.

Diode endovascular laser treatment in venous malformations of the upper aerodigestive tract.

PURPOSE: Venous malformations of the upper aerodigestive tract can cause pain, dysphagia, obstructive sleep apnea, and rarely bleeding. We studied 980-nm diode endovenous laser therapy. MATERIAL AND METHODS: This is a 2007-2014 retrospective study in our vascular anomalies center. Data on patients' clinical history, polysomnography, magnetic resonance imaging, and treatment were collected. Patients were contacted for Epworth Sleepiness Scale and Eating Assessment Tool (EAT-10) scores to evaluate sleepiness and dysphagia before and after laser therapy. RESULTS: We included 32 patients (mean age 41 years) presenting with obstructive sleep apnea (n = 18) and dysphagia (n = 13). With a mean follow-up of 39 months, average Epworth Sleepiness Scale score fell from 17.3 to 10.4 (p = 0.015), EAT-10 score from 8.2 to 3.5 (p = 0.002) and apnea-hypopnea index from 47.5 to 24.7 (p = 0.01). Of the sleep apnea patients, 89% required continuous positive airway pressure before and 50% afterward (p = 0.016). CONCLUSIONS: Diode endovascular laser treatment seems to be a safe and effective treatment option in venous malformations of the upper airways.

Recurrence patterns after endovenous laser treatment of saphenous vein reflux.

INTRODUCTION: The patterns of recurrent varicose veins after endovascular ablation of the saphenous veins are not well described. METHODS: The current study describes the ultrasound defined recurrence patterns seen in 58 patients (79 limbs) who returned for evaluation of recurrent varicose veins from a cohort of 802 patients treated with endovenous laser ablation and subsequent sclerotherapy from March 2000 to March 2007 with clinical follow-up until May 2014. FINDINGS: The most common ultrasound defined recurrence patterns leading to the varicose veins were new reflux in the anterior accessory saphenous and small saphenous veins as well as recanalization of the treated saphenous segment. Neovascularization at the saphenofemoral junction and incompetent perforating veins as the source of the recurrent veins were not seen. CONCLUSIONS: The patterns of recurrence following thermal ablation of saphenous veins are different to those seen after surgery. Specifically, new reflux in other saphenous veins is responsible for most recurrent varicose veins and neovascularity seems to be unusual following endovenous laser ablation.

Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatment of great saphenous varicose veins: Results of a multicentre randomised controlled trial with up to 6 years follow-up.

OBJECTIVES: High ligation and stripping was compared to endovenous laser ablation for the therapy of great saphenous vein varicosity. Long-term efficacy was assessed in terms of avoidance of inguinal reflux and mechanisms of recurrence were investigated. DESIGN: Multicentre, randomised, three-arm, parallel trial. MATERIALS AND METHODS: A total of 449 patients were randomised into three different treatment groups: high ligation and stripping group (n = 159), endovenous laser ablation group (n = 142; 980 nm, 30 W continuous mode, bare fibre) or a combination of laser ablation with high ligation (endovenous laser ablation group/ high ligation group, n = 148). Patients were examined clinically and by duplex ultrasound once a year.The primary end point of this study is inguinal reflux at the saphenofemoral junction after 2 years. This paper presents secondary data on sonographically determined inguinal reflux and clinical recurrences in the treated area after up to 6 years of follow-up. RESULTS: Median time to follow-up was 4.0 years; the mean time follow-up 3.6 years. Follow-up rates were: 2 years 74%, 3 years 47%, 4 years 39%, 5 years 36% and 6 years 31%. Most reflux into the great saphenous vein appeared in the endovenous laser ablation group (after 6 years: high ligation/stripping versus endovenous laser ablation p = 0.0102; high ligation/endovenous laser ablation vs. endovenous laser ablation p < 0.0002). Furthermore, more refluxive side branches were also observed in the endovenous laser ablation group (after 6 years high ligation/stripping vs. endovenous laser ablation p = 0.0569; high ligation/endovenous laser ablation vs. endovenous laser ablation p = 0.0111). In terms of clinical recurrence during the 6 years post therapy, no significant differences between the three treatment groups were observed (p values from log-rank test: high ligation/stripping vs. endovenous laser ablation p = 0.5479; high ligation/stripping vs. high ligation/endovenous laser ablation p = 0.2324; high ligation/endovenous laser ablation vs. endovenous laser ablation p = 0.0848).The postoperative decline and later development in Class C (clinical etiological anatomical pathological) went parallel in all groups. CONCLUSIONS: Clinical recurrence appears with the same frequency in all three treatment groups, but the responsible pathological mechanisms seem to differ. Most reflux into the great saphenous vein and side branches appears after endovenous laser ablation, whereas more saphenofemoral junction-independent recurrences are seen after high ligation/stripping.

Comparing cold and warm tumescent anesthesia for pain perception during and after the endovenous laser ablation procedure with 1470 nm diode laser.

OBJECTIVE: The aim of this study was to compare the pain perception and side effects during and after endovenous laser ablation with a 1470 nm diode laser using cold or room temperature tumescence anesthesia. METHODS: One hundred and one patients were randomly assigned in two groups. Group A received room temperature (+24℃) and Group B received cold (+4℃) tumescence fluid, which was used for local anesthesia in the track of great saphenous vein. A visual analog score was recorded immediately after the procedure. Patients were asked to register pain scores and the amount of pain medication consumed during the week. RESULTS: There was no significant difference concerning gender, age, Clinical Etiological Anatomical Pathological Classification, body mass index, or diameter of the treated vein. In Group A, the mean linear endovenous energy density was 59.5 J/cm and in Group B, it was 60.4 J/cm. The average visual analog score after the endovenous laser ablation procedure in Group A was 5 and in Group B was 2. Third day after the procedure, the average visual analog score in Group A was 3 and in Group B was 1. Patients in Group B needed significantly less analgesics compared with patients in Group A (p<0.05). The most frequent side effects in both groups were ecchymosis, induration, and minor paraesthesia, all of which were more common in Group A (p < 0.001). CONCLUSIONS: To date, most published endovenous laser ablation series describe the use of room temperature tumescence fluid infiltration of the perivenous stroma for tumescent analgesia and protection against thermal injury to the nearby structures. We describe an alternative technique using cold tumescence fluid infiltration, which is equally effective as, but safer than, room temperature tumescence fluid infiltration, and which yields better visual analog scores.