Endovenous Laser Treatment of Varicose Veins: Long-Term Results
PURPOSE: It is necessary to eliminate the highest point of reflux originating at the saphenofemoral junction (SFJ) and the great saphenous vein (GSV) to treat varicose veins. Minimal invasive alternatives in the treatment of varicose veins due to the SFJ and GSV incompetence have been tried over the years, resulting in various degrees of success depending on the method. Recently, endovenous laser occlusion using a diode laser has been introduced, with initial successful clinical reports. The present study was conducted to evaluate long-term follow-up results of endovenous laser treatment for closing the incompetent GSV at its junction with the femoral vein. METHOD: Forty limbs (thirty one patients) with reflux at the SFJ into the GSV were treated with 810nm or 940nm diode laser energy, administered endovenously through a bare-tipped laser fiber (600micrometer). The parameters were 12~15 W in a continuous mode, with a pulse of laser energy every second. A duplex doppler ultrasound (DDUS) was used to mark the location of the GSV from the knee to the SFJ. Vein access was achieved by using either the stab wound Mueller hook approach or ultrasound-guided needle puncture. Exact placement of the fiber was determined by direct observation of the aiming beam through the skin or ultrasound confirmation. Where necessary, a standard ambulatory phlebectomy was performed to remove remaining varicosities. Clinical and duplex evaluation was carried out at regular intervals (1, 3, 6, 12 months) following the initial treatment. RESULTS: Successful occlusion of the GSV, defined as absence of flow on the DDUS, was noted in 39 of 40 GSV (97.5%) during the last visit. Recanalization of GSV occurred in two limbs, 3 and 6 months after treatment. The GSV junction of 7 limbs had remained closed for 2 years. Side effects were minimal, with 21 limbs showing significant purpura, 6 limbs developing palpable fibrous cord and 4 limbs showing transient hyperpigmentation within less than 2 weeks to one month after treatment. CONCLUSION: Long-term results obtained from treatment of 40 limbs with endovenous laser treatment demonstrate a recurrence rate of less than 6% after 29 months of follow-up. These results are comparable or superior to those available for treatment of GSV reflux, including surgery, US-guided sclerotherapy, and radiofrequency ablation. Endovenous laser treatment appears to offer the benefit of lower rates of complication and the avoidance of general anesthesia.
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