Favorable long-term results of endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber

Introduction Endovenous laser ablation (EVLA) has become the gold standard for the treatment of saphenous vein reflux. We report the long-term clinical and ultrasound results of EVLA. Methods This study is a retrospective review of patients who underwent EVLA of saphenous vein over four years. Clinical results were assessed using venous clinical severity score (VCSS), and ultrasound results were classified according to Bush classification. Results Over a median follow-up time of 4.4 years, 168 EVLA-treated patients showed a drop in VCSS from 4.38 to 1.39. Ultrasound results of 140 treated great saphenous veins showed that 64% had one or more cause of recurrence. The presence of neovascularization correlated well with the lack of improvement of VCSS. Conclusion EVLA resulted in drop in VCSS from 4.38 to 1.39. Among 140 treated great saphenous veins, reflux in the anterior accessory saphenous vein was the primary cause (23.5%) of recurrence.

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Endovenous laser ablation of the great saphenous vein versus high ligation: long-term results

Lasers in Medical Science ◽

10.1007/s10103-013-1389-z ◽

2013 ◽

Vol 29 (2) ◽

pp. 765-771 ◽

Cited By ~ 10

Author(s):

Mohammad Mozafar ◽

Khashayar Atqiaee ◽

Hamidreza Haghighatkhah ◽

Morteza Sanei Taheri ◽

Ali Tabatabaey ◽

...

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Long Term Results ◽

High Ligation ◽

Endovenous Laser Ablation

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Endovenous Laser Ablation for Incompetent Saphenous Vein Combined With Fluoroscopy-Guided Endovenous Foam Sclerotherapy in Varicose Tributaries: Long-Term Follow-up Results

International Surgery ◽

10.9738/intsurg-d-15-00285.1 ◽

2016 ◽

Vol 101 (11-12) ◽

pp. 590-597

Author(s):

Song Am Lee ◽

Sang Woo Park ◽

Ik Jin Yun ◽

Jae Joon Hwang ◽

Jun Seok Kim ◽

...

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Duplex Ultrasound ◽

Long Term Results ◽

Foam Sclerotherapy ◽

Endovenous Laser Ablation ◽

Percutaneous Sclerotherapy ◽

Long Term Follow Up

The aim of this study is to describe the long-term results of 980-nm endovenous laser ablation (EVLA) combined with fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter into varicose tributaries. This report reviewed experiences with fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter followed by EVLA, from July 2005 to November 2007. The sclerosing foam was injected through the microcatheter using 1% polidocanol or sodium tetradecyl sulfate. Patients were evaluated clinically and with duplex ultrasound from 1 week to 3 years to assess treatment efficacy and adverse reactions. Technical success was seen in 460 of 461 limbs (99.8%). Continued closure of the saphenous veins and complete sclerosis of varicose tributaries were noted in 351 of 408 limbs (86%) at 1-month follow-up, all 328 limbs at 3-month follow-up, all 299 limbs at 6-month follow-up, all 146 limbs at 1-year follow-up, all 94 limbs at 2-year follow-up, and all 32 limbs at 3-year follow-up. No serious complications were noted. Bruising was noted in 79.0%, and pain or tightness was noted in 68.4%. Hyperpigmentation was noted in 54.2%. EVLA for incompetent saphenous vein combined with endovenous foam sclerotherapy appears to offer the obvious benefits of less additional percutaneous sclerotherapy. However, many problems, like long-lasting pain and hyperpigmentation, can lessen the value of this procedure.

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Study on the Long-Term Results of Endovenous Laser Ablation for Treating Varicose Veins

International Journal of Angiology ◽

10.1055/s-0035-1555749 ◽

2015 ◽

Vol 25 (02) ◽

pp. 117-120 ◽

Cited By ~ 2

Author(s):

Seung Go ◽

Yun Mun ◽

Yoon Kang ◽

Hye Ahn ◽

Byung Cho

Keyword(s):

Laser Ablation ◽

Varicose Veins ◽

Long Term Results ◽

Endovenous Laser Ablation

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Current clinical evidence on endovenous laser ablation (EVLA) from randomised trials

Phlebologie ◽

10.12687/phleb2317-4-2016 ◽

2016 ◽

Vol 45 (04) ◽

pp. 201-206 ◽

Cited By ~ 2

Author(s):

K. Rass

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Term Treatment ◽

High Ligation ◽

Control Group ◽

Foam Sclerotherapy ◽

Endovenous Laser Ablation ◽

Treatment Approaches ◽

Long Term Treatment

SummaryBackground Endovenous laser ablation (EVLA) is globally counted among the most frequently administered methods to treat saphenous vein incompetence. Technical development proceeded in three particular steps: EVLA #1 – Diode lasers linearly emitting wavelengths from 810 to 980 nm through optical bare fibres; EVLA #2 – Diode or Nd:YAG lasers emitting wavelengths from 1064 to 1500 nm; EVLA #3 – Modified optical fibres warranting an optimised emission geometry by centralisation of the fibre tip (Tulip-fibre, Jacket-tip) or radial emission of the laser beam. Due to the number of different EVLA techniques their value compared with standard surgery (high ligation and stripping, HLS) and other endovascular approaches has to be questioned.Methods Selective literature analysis based on a systematic PubMed search focussed on randomised controlled trials (RCT) comparing EVLA with HLS and other thermal or nonthermal ablation techniques – radiofrequency ablation (RFA), ultrasound guided foam sclerotherapy (UGFS), endothermal steam ablation (EStA).Results The search terms “endovenous”, “laser”, “varicose vein” resulted in 509 publications, hereof 57 RCTs, hereof 24 randomised studies comparing EVLA with other treatment approaches: 15 studies comprise comparisons with standard surgery and further 9 studies with other endovenous techniques. 6 RCTs contain long-term followup data on EVLA #1 vs. HLS suggesting superiority of HLS in terms of same site clinical and duplex detected recurrence from the groin. 15 RCTs are reporting short-term results clearly demonstrating inferiority of EVLA #1 against EVLA #2, EVLA #3, and RFA with respect to postoperative complaints and patients’ quality of life.Conclusions The first generation endovenous laser systems are disadvantageous or even harmful as compared with more advanced EVLA techniques and RFA in terms of patients’ complaints and side effects. Furthermore, evidence is rising that EVLA #1 is inferior to standard surgery regarding long-term treatment efficacy. Therefore, the application of EVLA #1 in the treatment of saphenous vein incompetence cannot be recommended any longer. In view of the more recently published RCTs reporting long-term superiority of standard surgery, HLS should still be implemented as control group in studies investigating endovenous treatment approaches.

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Endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2014.04.012 ◽

2014 ◽

Vol 2 (4) ◽

pp. 403-410 ◽

Cited By ~ 7

Author(s):

Giorgio Spreafico ◽

Andrea Piccioli ◽

Enrico Bernardi ◽

Enzo Giraldi ◽

Patrizia Pavei ◽

...

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Endovenous Laser Ablation ◽

Radial Fiber

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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

Phlebology The Journal of Venous Disease ◽

10.1177/0268355516658592 ◽

2016 ◽

Vol 32 (6) ◽

pp. 415-424 ◽

Cited By ~ 16

Author(s):

Malcolm Sydnor ◽

John Mavropoulos ◽

Natalia Slobodnik ◽

Luke Wolfe ◽

Brian Strife ◽

...

Keyword(s):

Patient Satisfaction ◽

Radiofrequency Ablation ◽

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Clinical Severity ◽

Endovenous Laser Ablation ◽

Venous Clinical Severity Score ◽

Superficial Venous Insufficiency

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.

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Patency of Anterior Accessory Saphenous Vein Following Endovenous Laser Ablation for Varicose Veins: Bare-Tip Versus Radial Fiber

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.06.770 ◽

2019 ◽

Vol 58 (6) ◽

pp. e200-e201

Author(s):

Tsuyoshi Shimizu ◽

Ayaka Shiraishi ◽

Rie Horiuchi

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Varicose Veins ◽

Endovenous Laser Ablation ◽

Radial Fiber

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Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein? Review

Vascular ◽

10.1177/1708538116648035 ◽

2016 ◽

Vol 24 (6) ◽

pp. 649-657 ◽

Cited By ~ 12

Author(s):

Renata Balint ◽

Akos Farics ◽

Krisztina Parti ◽

Laszlo Vizsy ◽

Jozsef Batorfi ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Success Rates ◽

Technical Success ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

Endovenous Laser Ablation

Objective The aim of this review article was to evaluate the long-term technical success rates of the known endovenous ablation procedures in the treatment of the incompetence of the great saphenous vein. Methods A literature search was conducted in the PubMed-database until the 5 January 2016. All publications with four to five years follow-up were eligible. Meta-analysis was performed by the IVhet-model. Results Eight hundred and sixty-two unique publications were found; 17 of them were appropriate for meta-analysis. Overall, 1420 limbs were included in the trial, 939 for endovenous laser ablation, 353 for radiofrequency ablation and 128 for ultrasound guided foam sclerotherapy. Overall, technical success rates were 84.8% for endovenous laser ablation, 88.7% for radiofrequency ablation and 32.8% for ultrasound guided foam sclerotherapy. There were no significant differences between endovenous laser ablation, radiofrequency ablation and ultrasound guided foam sclerotherapy regarding the great saphenous vein reopening ( p = 0.66; OR: 0.22; 95% of CI: 0.08–0.62 for radiofrequency ablation vs. endovenous laser ablation; p = 0.96; OR: 0.11; 95% of CI: 0.06–0.20 for endovenous laser ablation vs. ultrasound guided foam sclerotherapy; p = 0.93; OR: 3.20; 95% of CI: 0.54–18.90 for ultrasound guided foam sclerotherapy vs. radiofrequency ablation). Conclusion Both endovenous laser ablation and radiofrequency ablation are efficient in great saphenous vein occlusion on the long term. Lacking long-conducted large trials, the efficacy and reliability of ultrasound guided foam sclerotherapy to treat great saphenous vein-reflux is not affirmed.

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