Clinical Analysis of Endovenous Laser Treatment Combined with High Ligation for Treatment of Varicose Vein

PURPOSE: Endovenous laser treatment (EVLT) for varicose vein has been shown to be an effective method of treatment. But, after EVLT, recurrence due to recanalization of the great saphenous vein has been identified as a complication. This study was performed to evaluate the effectiveness of EVLT combined with high ligation and to assess the recurrence rate. METHODS: Between April 2004 and April 2009, medical records of 163 patients treated with EVLT combined with high ligation and stab phlebectomy were reviewed retrospectively. Duplex ultrasonography was performed before surgery. All patients were followed up with clinical evaluation at 1 week and 1, 3, and 6 months after operation. The mean follow up period was 5.9 months. RESULTS: In total, 178 limbs of 163 patients were reviewed. In our study, almost all (98.8%) patients had symptomatic and cosmetic improvement. We observed complications such as ecchymosis (22.1%), edema (12.9%), pain (5.5%), and in one case, hematoma. Ecchymosis, edema, and pain were controlled by conservative treatment. The patient with hematoma was hospitalized and improved with conservative therapy. There were no cases of recanalization during the follow up period. CONCLUSION: Compared to previous studies, EVLT combined with high ligation showed satisfactory results, with no recurrence. However, the longer operation time and higher cost were issues and further studies are necessary for objective comparison.

Comparative Study of Postoperative Complications of High Ligation and Stripping with Endovenous Laser Treatment for Varicose Veins

PURPOSE: Endovenous laser treatment (EVLT) has been performed as a minimally invasive alternative to conventional surgery for saphenous vein incompetence. It is thought to minimize postoperative complications and improve the quality of life compared with high ligation and stripping. The aim of this retrospective study was to compare the postoperative complications and quality of life of EVLT with high ligation and stripping (HS). METHODS: A total of 294 patients with 390 saphenous veins were included in this study. Patients with saphenous vein incompetence were treated with either HS (n=98; HS group) or EVLT (n=196; EVLT group). Patients were evaluated preoperatively and at 1, 3 months, postoperatively. Postoperative complications, the Venous Clinical Severity Score (VCSS) and the Aberdeen Varicose Vein Symptom Severity Score (AVSS) were compared between the two groups. RESULTS: The total postoperative complication rate was 31.62%, in HS and 27.47% in the EVLT groups. Most of the complications were minor and self-limited. There were no statistical differences in the total complication rate and the occurrence of complications such as hematoma, paresthesia and phlebitis. Pain was less severe following EVLT compared to HS. The EVLT patients were discharged and resumed their normal activity earlier than the HS patients. The two groups had similar improvement of the VCSS and AVSS at 1 and 3 months, postoperatively. CONCLUSION: With the similar, comparable short-term safety outcome, both HS and EVLT may be considered as safe procedures for the treatment of varicose veins. Long-term, large population-based randomized studies with promising data for the improvement of quality of life scores will be needed for the evaluation of EVLT before it becomes a standard treatment for saphenous vein incompetence.

The Evaluation of the Saphenofemoral Junction after Endovenous Laser Treatment for Varicose Veins and Its Clinical Significance

PURPOSE: The aim of this study is to evaluate the anatomy of the saphenofemoral junction (SFJ) after endovenous laser treatment (EVLT) with using a duplex scan and to assess its clinical significance. METHODS: Thirty two limbs of 26 patients who underwent EVLT between 2004 and 2006 were examined with duplex ultrasound scanning. The mean follow-up time was 25.9 months. We evaluate the presence of reflux, the patency of the proximal great saphenous vein and the number of the remaining patent tributary veins. RESULTS: The occlusion of the SFJ was classified into four categories 1) complete obstruction in 7 (21.9%), 2) complete obstruction with only one patent tributary vein in 6 (18.8%), 3) near complete obstruction (the patent length of the greater saphenous vein 5 cm) in 1 case. A patent SFJ with one or more intact tributaries was present in 25 (78.1%) limbs. However, there was no reflux in all the cases. CONCLUSION: EVLT is an effective and minimally invasive treatment for varicose veins. Although the SFJ tributaries and the patency of the proximal great saphenous vein after endovenous laser treatment were present, there was no reflux or recurrence of varicose veins.

Comparative Study of Endovenous Laser Treatment with Different Laser Wavelength for Saphenous Vein Incompetence

PURPOSE: Limited data is available about the relative effects of laser wavelengths when conducting endovenous laser treatment (EVLT) for saphenous vein incompetence. We performed this study to compare the safety and efficacy between EVLT with using an 810 nm and a 1,320 nm laser. METHODS: 147 incompetent saphenous veins in 101 consecutive patients who were treated with EVLT were included in this study. We divided them into two groups: 810 in the nm laser group (Group A: 85 saphenous veins in 52 patients) and 1,320 in the nm laser group (Group B: 62 saphenous veins in 49 patients). The patients were evaluated with Doppler sonography to evaluate the results of the treatment at 1 and 3 months after the procedure. Symptomatic improvement was compared between the groups according to the venous clinical severity score (VCSS), the Averdeen varicose vein symptom severity score (AVSS), the complications, the recurrences and the recanlization rate. RESULTS: There was a statistically significant difference in an average linear endovenous energy density (LEED) between two groups. During the mean follow-up of 139 days in Group A and 116 days in Group B, more complications occurred in Group A (42.3%) than that in Group B (32.7%). The postoperative clinical improvement was similar between the two groups for the VCSS and AVSS. The ultrasonography (USG)-proved recanalizaton rates at postoperative 1 and 3 months were 1.2% and 4.3% in Group A and 1.6% and 1.9% in Group B, respectively. Recurrences occurred in only 2 cases in Group A. CONCLUSION: EVLT with a 1,320 nm laser had a tendency to develop fewer complications, recurrences and USG-proven recanalizations of the saphenous veins. Long-term data from large randomized prospective trials is needed to confirm the safety and efficacy of this operative procedure.

Intermediate Stage Report about Change of Deep Venous Valve Function after Superficial Vein Surgery of Lower Extremity / 中国普外基础与临床杂志

Objective To evaluate improved effect for deep venous valve function after superficial vein surgery of lower extremity in the intermediate stage.Methods Totally 43 patients (55 limbs) with varicose veins of lower extremity were enrolled to accept surgical management of vein systems in our department from March 2006 to October 2006.All patients were respectively followed up after 6 months and 4 years about the changes of deep venous valve function with color Doppler ultrasonography.Results Thirty-nine patients’ deep venous valve function kept well up to now,and there was no significant difference between the two results.Four patients without proximal saphenous vein ligation recurred,and there was reflux in deep venous.Conclusion Endovenous laser treatment and ablation of varicose veins of lower extremity with deep venous insufficiency could improve deep venous valve function effectively.Proximal great saphenous vein ligation is important for successful operation.

Short Term Results of Endovenous Laser Treatment with Ultrasound Guided Ligation of the Sapheno-femoral Junction or Sapheno-popliteal Junction in Patients with Varicose Vein

PURPOSE: The main cause of recurrence of varicosity after endovenous laser treatment (EVLT) is incomplete occlusion of the sapheno-femoral junction (SFJ) or the sapheno-popliteal junction (SPJ). To reduce the recurrence and complications of EVLT, we have tried to ligate the SFJ or SPJ under ultrasonic guidance. METHOD: Two separate parallel punctures were made under ultrasonic guidance 1 cm inferior to and alongside the SFJ or SPJ with using a 16 gauge needle. A hook was passed through beneath the saphenous vein and it was pulled out through the puncture holes. A black silk thread was passed through backward with the hook and then the thread was tied. Low energy EVLT was then performed in a continuous fashion with using a 980 nm multidiode laser. RESULT: Between December, 2007 and February, 2008, 21 patients (males: 14, females: 7, 28 legs, mean age: 45 years old) with including 20 great saphenous veins (GSV) and 8 small saphenous veins (SSV) were managed using our protocol. The mean energy density (ED) was 9.8J/cm for the GSV and 9.5J/cm for the SSV. The pullback speed on the fiber was 69.5 sec at the GSV and 28sec at the SSV. No recurrence was noted. The complications were bruise (7 limbs/24%), fibrotic cord (4 limbs/14%), pain (8 limbs/31%), inguinal pain and paresthesia (1 limb/3%) and hematoma (4 limbs/14%). These complications were well controlled without any further problems. CONCLUSION: During EVLT, ultrasound (US) guided ligation of the SFJ is cosmetically satisfactory and effective in reducing the amount of required endovenous laser energy. The complication rate and severity were not reduced, but they under control.

Clinical Analysis of Endovenous Laser Treatment for Primary Varicose Vein Reflux

PURPOSE: Endovenous laser treatment for incompetent great saphenous vein (GSV) has been recently proposed as an effective means of treatment. The aim of this study is to identify the complications and safety of EVLT as the main treatment for primary varicose vein incompetence when used concomitantly with miniphlebectomy and sclerotherapy. METHODS: We reviewed the records of 153 patients who underwent EVLT. Venous duplex scanning was performed 3 months after surgery in all the patients. The clinical outcomes were evaluated using questionnaires at the outpatient clinic or through phone calls. RESULTS: Considering the 97% satisfaction rate of EVLT, EVLT was an effective treatment for primary varicose vein. We observed complications such as paresthesia (20.9%), pain lasting more than 2 weeks (11.8%), ecchymosis or bruising (7.2%) that subsided spontaneously, superficial burn (5.2%) and phlebitis (2%) that was controlled by conservative treatment. The GSV recanalization rate 3 months after the procedure was 3.3%, resulting in a 96.7% success rate. CONCLUSION: The early results indicate that EVLT is an effective and safe procedure to eliminate the SFJ (sapheno-femoral junction) and obliteration of the GSV. However, long-term follow-up is necessary in our study. Better treatment outcomes are possible with accumulated experience and the establishment of strict indications for EVLT.

Endovenous Laser Treatment (EVLT) with High Ligation of Small Saphenous Vein Varicosities

PURPOSE: Endovenous laser treatment (EVLT) of great saphenous vein (GSV) varicosities is a widely accepted procedure. However, EVLT of small saphenous vein (SSV) varicosities is not so popular due to concern about sural nerve damage and popliteal thrombosis. In addition, higher rates of recanalization and recurrence of tributaries make clinicians reluctant to use EVLT for SSV incompetence. The purpose of this study is to assess the safety and efficacy of SSV EVLT and the advantage of a combined high ligation and EVLT to reduce the complications and recurrence. METHOD: Between November 2003 and March 2006, 47 patients (55 limbs) with SSV incompetence and enlarged truncal varicosities, documented by duplex ultrasound, were included in the study. All patients were treated with an EVLT combined with ambulatory phlebectomy (AP) of the residual varicosities. High ligation of the sapheno-popliteal junction (SPJ) was performed in 26 limbs (47.3%, HL group); the EVLT without high ligation was performed in another 29 limbs (52.7%, NHL group). The patients were followed by clinical examinations at 1 week, 4 weeks and 12 weeks and with duplex ultrasound at 12 weeks after the operation. Symptomatic improvement, complications, recanalization of the SSV and recurrence of tributaries were recorded and compared between the two groups. RESULT: Mean follow-up was for 5.0 months. Most of the patients (95.4%) showed symptomatic improvement at 12 weeks with better venous clinical severity scores (VCSS). The overall complication rate was 27.3% (15 limbs), most of them were minor problems including 4 cases of transient sural nerve numbness (7.3%). The duplex US-confirmed saphenous vein recanalization rate and recurrence rate of tributaries at 3 months were 5.4% and 9.1%, respectively. There were no differences in the rate of symptomatic improvement and complications between the HL and NHL groups. However, the HL group showed a lower tendency for recanalization and recurrence compared to the NHL group. CONCLUSION: EVLT combined with AP might be an effective minimally invasive treatment modality for SSV varicosities with an acceptable complication rate and low recanalization rate of the saphenous veins. The simultaneous high ligation of the SPJ decreased the rates of recanalization and recurrence. Long-term data from large randomized prospective trials with more objective measure of the outcomes are needed to confirm the effectiveness and durability of this operative procedure.

Endovenous Laser Treatment (EVLT) Combined with Stab Phlebectomy (SP) for Lower Extremity Varicose Veins

PURPOSE: For the treatment of residual visible tributaries following minimally invasive saphenous vein ablation procedures such as endovenous laser treatment (EVLT) and radiofrequency ablation (RF), a variety of options including observation, sclerotherapy, ultrasonography-guided sclerotherapy, stab phlebectomy (SP) and additional laser therapy have been developed. We performed endovenous laser treatment combined with stab phlebectomy and we evaluated the early results to assess the efficacy and safety of this procedure. METHODS: Between February 2003 and February 2006, one hundred twelve venous insufficiencies of the lower limbs in 106 patients (46 men and 60 women; mean age: 51.7 years) were treated with EVLT combined with SP. According to the CEAP classification, 103 limbs were C2, and nine were C3/C4. 810-nm diode laser energy was delivered percutaneously into the saphenous veins (86 GSVs, 20 SSVs, 6 GSV+SSVs). All patients were followed up on an outpatient basis and duplex ultrasonography (US) was performed 3 months after operation. RESULTS: The mean follow-up period was 2.92 months. All the patients had symptomatic improvement and immediately returned to normal daily activities. The overall complication rate was 36.6% (41 cases), and most of them were minor problems including ecchymosis in 22, paresthesia in 8, induration in 5 and excessive pain in 2. Three cases of cellulitis or thrombophlebitis were present and this resolved with drainage and antibiotics. One case of foot drop developed, but this improved with active physiotherapy within a few months. No postprocedural symptomatic deep vein thrombosis occurred. The recurrence rate of tributaries at 3 months was 13.6%, but these were easily controlled by sclerotherapy if needed. The duplex US-confirmed saphenous vein recanalization rate at 3 months was 5.9%. CONCLUSION: EVLT combined with SP could be a novel minimally invasive modality for treating lower extremity varicose veins with an acceptable complication rate and a low recanalization rate of the saphenous veins. It could lessen the possibility of additional treatments for the residual visible tributaries and so improve the satisfaction index, along with the cosmetic and economic advantages. However, long-term follow up and postoperative duplex US with an additional objective index examination are required to confirm the effectiveness and durability of this operative procedure.

Endovenous Laser Treatment of Varicose Veins: Long-Term Results / 대한피부과학회지

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.

Clinical Study of Endovenous Laser Treatment in Short Saphenous Vein Varicosity

PURPOSE: With regard to the selection of varicose treatment, conventional therapy such as stripping and ligation has became unpopular but the selection of endovenous radiofrequency coagulations (RF) or endovenous laser treatment (EVLT) of the greater saphenous varicose vein have increased as they are more convenient for patient. Mipiphlebectomy (MP) and sclerotherapy (SC) have also been welcome due to the advantages of less scaring and a rapid return to work. Therefore, varicose vein of the greater saphenous vein (GSV) and its tributaries are well controlled by new modalities, such as RF, EVLT, MP and SC, but those of the short saphenous vein (SSV) are difficult to control because of the many tributaries and perforating veins. A new modality with a simultaneous EVLT +/-MP combination for the treatment of SSV varicosities has been used. METHOD: 27 cases of SSV varicosities in 24 patients, between Feb 2002 and May 2004, were included in this study. The series of patients were followed up for recurrence of varisose vein, SSV recanalization and complications. RESULT: The patients were grossly examined postoperatively, and doppler were checked, and the varicose recurrence rates at 1, 3 and 6 months were found to be 0, 7.4 (2/27) 25.9% (7/27), espectively, the Doppler SSV recanalization rates at 1, 3 and 6 months were 0, 0 and 11.1% (3/27) and tributaries recurrence rates were 0, 7.4 (2/27) and 14.8% (4/27) with recurrence controlled by MP or SC, or observed for progression only. Most patients (93.6%) were satisfied with our treatment modality, and complications, such as pain, hematoma and swelling were controlled within 1 month, with 3 cases of tingling sensation of calf that subsided spontaneously. CONCLUSION: The control of SSV varicosities wes a little hard due to the many recurrences after surgery or EVLT alone. In our study, the cases of SSV varicosity alone were collected, and combination therapy, such as EVLT with miniphlebectomy, wes effective, as indicated by the relatively few recurrences, and even in these recurrence cases, additional postoperative MP or SC was enough for patient's satisfaction.

Comparison of Immediate Therapeutic Effects Between Endovenous Laser Treatment and Conventional Surgical Therapy for Lower Extremity Varicosity / 中国普外基础与临床杂志

Objective To compare the immediate therapeutic effects between endovenous laser treatment and conventional surgery for lower extremity varicosity.Methods Data of 350 limbs of 275 patients treated by endovenous laser treatment (endovenous laser treatment group) and 310 limbs of 210 patients by traditional surgery (traditional surgery group) were analyzed and compared in terms of operation time,number of the incision,postoperative pain,complications,postoperative hospitalized duration and 1-year recurrence rate.Results Endovenous laser treatment group had shorter operation time,fewer incisions,less postoperative pain and shorter postoperative hospitalized duration than traditional surgery group (P0.05).Conclusion As a safe and effective new treatment for lower extremity varicosity with minimal invasiveness and no left scars,endovenous laser treatment has the potential to replace conventional surgery and extend the surgical indications for lower extremity varicosity treatment.

Causes and Prevention of Complications in Endovenous Laser Treatment for Patients with Varicose Great Saphenous Veins / 中国微创外科杂志

Objective To discuss the causes and therapies for the complications induced by endovenous laser treatment (EVLT) in patients with varicose great saphenous vein. Methods From August 2003 to February 2007,totally 342 patients (530 limbs) with varicose great saphenous veins were treated by high ligation combined with EVLT in our hospital. Operative compilations were found in 186 of the limbs.The data of the 186 limbs were analyzed retrospectively. Results The patients were followed up for 6 months,during which 23 limbs showed skin bruises and/or hematoma,65 develped phlebitis,and 20 had skin burns; all of these cases were cured. In addition,77 limbs were diagnosed as having saphenous nerve damage (abnormal skin sensation),57 of them were cured and 20 were improved after treatments. Deep vein thrombosis complicated with pulmonary embolism was found in one case,who was improved after therapies. Conclusions To prevent the complications of EVLT combined with high ligation of the saphenous vein,intraoperative adjustment of laser power according to the surgical sites,gentle operation,postoperative administration of anticoagulants,and early rehabilitation are recommended.

The evaluation of complications after endovenous laser treatment for patients with varicose veins of the lower extremities / 中国普通外科杂志

Objective To explore causes of complications after endovenous laser treatment (EVLT) , for patients with superficial varicosities of the lower extremities. Methods In this study, 207 patients with a total of 268 lower limbs were treated by EVLT combined with surgical procedures. According to CEAP classification, there were C2 in 268 limbs, C3 in 56 limbs, C4 in 101, C5 in 23 and C6 in 18. Simple EVLT was performed for 25 limbs in 21 patients; EVLT combined with external banding valvuloplasty of superficial femoral vein for 23 limbs in 23 patients; EVLT combined with ligation of great saphenous vein (CSV) and denudation of superficial varicosities for 220 limbs in 163 patients. Results An average of 10?5 (3-24) months of follow up was achieved in 175 cases. Early complications (within the first 2-weeks after operation) included bruising or ecchymosis (178 cases, 66.42%) and skin burning (56, 20.90% ). Three month complication included painful induration or trabs (235 cases, 87. 69% ) as well as thrombophlebitis (28, 10. 45% ). Long-term complication (after 3 months) included skin numbness or pain at medial knee or ankle region (15,5. 60% ). Recanalization of CSV occurred in 4( 1. 49% ) treated limbs. Residual or reoccurred varicose veins were found in 13(4. 85% ) cases. Movement related swelling appeared in 6(2. 24% ) lower limbs. Conclusion EVLT is effective for patients with superficial varicosities of the lower extremities. Minor complications most often subsided within 3 months. Strict surgical protocol and high ligation of the GSV could prevent local recurrence of the varicose veins and the recanalization of GSV.

Endovenous laser treatment of varicose veins of lower extremities / 重庆医科大学学报

Objective:To assess the indication,preliminary efficacy and complication of endovcnous laser treatment (EVLT) for varicose veins.Methods:A study was carried out on 63 limbs of 38 patients with varicose veins.59 of 63 limbs were treated by EVLT and 4 of 63 limbs were treated by both EVLT and surgical ligation.Patients were evaluated at 3,7 days and 1,3,9 months to determine efficacy and complications.Results:62 of 63 greater saphenous veins were closed after treatment,and the remaining one was closed after repeat treatment.There were no significant complications and no recurrence at 2～9 months after treatment.Conclusion:Endovenous laser treatment of varicose veins of lower extremities is a safe,effective and feasible method.It can be applied to the patient of clinical stages C_2～C_6 according to CEAP classification and can be cooperated with surgical ligation without serious complications.