Feasibility and safety of flush endovenous laser ablation of the great saphenous vein up to the saphenofemoral junction

Objectives To evaluate the incidence of heat-induced thrombosis, its progression and risk factors that may contribute to its formation after endovenous laser ablation. Methods This was a prospective evaluation of all patients who had endovenous laser ablation of the great saphenous vein, accessory saphenous vein, and small saphenous vein using 1470 nm wavelength laser, from March 2010 to September 2011. All patients who developed endovenous heat-induced thrombosis at the saphenofemoral junction or at the saphenopopliteal junction were included. Demographic data, history of venous thrombosis, body mass index, vein diameter, reflux time, catheter tip position, endovenous heat-induced thrombosis progression, number of phlebectomies, and venous clinical severity scores were analyzed. Duplex ultrasound was done in all patients preoperatively, and 2–3 days postoperatively. Results Endovenous laser ablation was performed in 2168 limbs. Fifty-seven percent had great saphenous vein, 13% accessory saphenous vein, and 30% small saphenous vein ablation. Endovenous heat-induced thrombosis was developed in 18 limbs (12 at saphenofemoral junction and six at saphenopopliteal junction) for an incidence of 0.9%. Eight were class 1 and 10 were > class 2. No pulmonary embolism was reported. The percentage of men with endovenous heat-induced thrombosis was higher compared to those without (39% vs. 24%, p = .14). The median age for endovenous heat-induced thrombosis patients was 59.6 compared to non-endovenous heat-induced thrombosis ( p = .021). Great saphenous vein/accessory saphenous vein diameter for endovenous heat-induced thrombosis patients was 8.0 mm versus 6.3 mm for non-endovenous heat-induced thrombosis patients ( p = .014), and for small saphenous vein it was 5.7 mm versus 4.5 mm ( p = .16). Multiple concomitant phlebectomies were performed in 55.6% of the endovenous heat-induced thrombosis patients compared to 37% in non-endovenous heat-induced thrombosis ( p = .001). All other parameters were similar between endovenous heat-induced thrombosis and non-endovenous heat-induced thrombosis group. Endovenous heat-induced thrombosis resolution occurred in 16 cases at 2–4 but two cases progressing from class 1 to 2, before resolution. The mean VCSS score for endovenous heat-induced thrombosis patients preoperatively was 5.6 and improved to 2.8 ( p = .003) at one month. Conclusion Risk factors associated with endovenous heat-induced thrombosis formation after endovenous laser ablation include: vein size, age, and multiple phlebectomies. Endovenous heat-induced thrombosis resolves in 2–4 weeks in most patients but it may worsen in few.

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Randomised clinical trial comparing endovenous laser ablation of the great saphenous vein with and without ligation of the saphenofemoral junction, with a two-year follow-up

http://isrctn.org/> ◽

10.1186/isrctn60300873 ◽

2012 ◽

Author(s):

Ben Disselhoff

Keyword(s):

Clinical Trial ◽

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Randomised Clinical Trial ◽

Endovenous Laser Ablation ◽

Saphenofemoral Junction

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Endovenous Laser Ablation for Treatment of a Partially Thrombosed Proximal Great Saphenous Vein

Case Reports in Vascular Medicine ◽

10.1155/2019/1726978 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Luca Spinedi ◽

Hans Stricker ◽

Daniel Staub ◽

Heiko Uthoff

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Alternative Treatment ◽

Great Saphenous Vein ◽

Superficial Vein ◽

Endovenous Laser Ablation ◽

Vein Thrombosis ◽

Alternative Treatment Option ◽

Superficial Vein Thrombosis ◽

Saphenofemoral Junction

Introduction. Superficial vein thrombosis of the great saphenous vein near to the saphenofemoral junction is generally treated with anticoagulation or surgically. Report. We present the case of a 70-year-old man with varicosities and a partially thrombosed great saphenous vein near to the saphenofemoral junction, treated with endovenous laser ablation of the great saphenous vein. Discussion. The case illustrates an alternative treatment option for superficial vein thrombosis of the great saphenous vein, which permits avoiding a prolonged anticoagulation or surgical procedure.

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Five-year Results of a Randomised Clinical Trial of Endovenous Laser Ablation of the Great Saphenous Vein with and without Ligation of the Saphenofemoral Junction

Journal of Vascular Surgery ◽

10.1016/j.jvs.2011.03.228 ◽

2011 ◽

Vol 53 (5) ◽

pp. 1451 ◽

Cited By ~ 1

Author(s):

B.C.V.M. Disselhoff ◽

D.J. der Kinderen ◽

J.C. Kelder ◽

F.L. Moll

Keyword(s):

Clinical Trial ◽

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Randomised Clinical Trial ◽

Endovenous Laser Ablation ◽

Saphenofemoral Junction

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Feasibility and potential significance of prophylactic ablation of the major ascending tributaries in endovenous laser ablation (EVLA) of the great saphenous vein: A case series

PLoS ONE ◽

10.1371/journal.pone.0245275 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245275

Author(s):

Lars Müller ◽

Jens Alm

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Negative Impact ◽

Multiple Logistic Regression Analysis ◽

Case Series ◽

Technical Success ◽

Endovenous Laser Ablation ◽

Related Data ◽

Saphenofemoral Junction

Background Recurrent varicosities after endovascular laser ablation (EVLA) of the great saphenous vein (GSV) are frequently due to varicose transformed, initially unsealed major ascending tributaries of the saphenofemoral junction (SFJ). Preventive ablation of these veins, especially the anterior accessory saphenous vein, is discussed as an option, along with flush occlusion of the GSV. However, few related data exist to date. Methods A consecutive case series of 278 EVLA procedures of the GSV for primary varicosis in 213 patients between May and December 2019 was retrospectively reviewed. The ablations were performed with a 1470 nm dual-ring radial laser and always included flush occlusion of the GSV, and concomitant ablation of its highest ascending tributaries by additional cannulation and ablation when this seemed anatomically appropriate. The initial technical success, comprising occlusion of the GSV and its major tributaries, was set as the primary endpoint. Possible determinants were explored using downstream multiple logistic regression analysis. Results The early technical success was 92.8%, with the GSV occluded in 99.6% and the highest ascending SFJ tributary, if present, in 92.4%. Additional ablations of ascending tributaries were performed in 171 cases (61.5%), the latter being associated with success (OR 10.39; 95% CI [3.420–36.15]; p < 0.0001). Presence of anterior as opposed to posterior accessory saphenous vein was another positive predictor (OR 3.959; 95% CI [1.142–13,73]; p = 0.027), while a confluence of the tributary in the immediate proximity to the SFJ had a negative impact (OR 0.2253; 95% CI [0.05456–0.7681]; p = 0.0253). An endothermal heat-induced thrombosis (EHIT) ≥ grade 2 was observed in three cases (1.1%). Conclusions A co-treatment of the tributaries is feasible and could improve the technical success of EVLA if a prophylactic closure of these veins is desired, especially if their distance to the SFJ is short. Its effect on the recurrence rate needs further research.

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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

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514555547 ◽

2014 ◽

Vol 31 (1) ◽

pp. 23-33 ◽

Cited By ~ 37

Author(s):

I Flessenkämper ◽

M Hartmann ◽

K Hartmann ◽

D Stenger ◽

S Roll

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

High Ligation ◽

Rank Test ◽

Clinical Recurrence ◽

Endovenous Laser Ablation ◽

Treatment Groups ◽

Saphenofemoral Junction

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.

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