Technique and early results of endovenous laser ablation in morphologically complex varicose vein recurrence after small saphenous vein surgery

TY - JOUR

T1 - Technique and early results of endovenous laser ablation in morphologically complex varicose vein recurrence after small saphenous vein surgery

AU - Müller, Lars

AU - Debus, Eike Sebastian

AU - Karsai, Syrus

AU - Alm, Jens

N1 - Copyright: © 2024 Müller et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2024/10/11

Y1 - 2024/10/11

N2 - BACKGROUND: Recurrences after varicose vein treatment occur frequently and represent a significant health and economic problem. In contrast to primary treatments of superficial truncal venous insufficiency, their management is often more difficult. Here we assessed the technical feasibility and early results of endovenous laser ablation (EVLA) for recurrences with stumps or subfascial meandering varices after small saphenous vein (SSV) surgery.METHODS: This single-center retrospective study included 45 consecutive EVLA procedures from July 2019 to December 2021 in 40 patients (19 male, 21 female, mean age 62.8 ± 12.7 years). Patients had clinically relevant recurrent varicose veins after SSV surgery, with clinical, etiologic, anatomic and pathophysiologic (CEAP) classification stage of C2S or higher. We categorized the recurrences morphologically according to duplex sonographic criteria. Ablations were done with a 1470 nanometers laser and dual ring radial fibers and aimed at thermal closure as proximal as possible to the upper inflow. Analyses were performed by descriptive statistics and the Kaplan-Meier method. The primary outcome analyzed was the technical success, defined by thermal occlusion not requiring re-intervention during the observation period. The secondary outcome was the occurrence of postoperative complications.RESULTS: A complex morphology with residual stumps or tortuous venous connections to the popliteal vein was present in 35 cases (77.8%). Immediate technical success at the first postoperative visit after a median of 11 days (interquartile range 8-13 days) was 97.8%. During the follow-up period (median 77 days, interquartile range 13-256 days), 6 limbs (13.3%) required redo EVLA due to symptomatic persistent or newly presenting reflux. The median freedom from re-recurrence was 791 days. Otherwise, no medical or surgical complications requiring specific treatment were observed, particularly no endothermal heat-induced thrombosis (EHIT) or other thrombotic complications, and no nerve damage.CONCLUSION: According to our pilot data, EVLA is technically feasible for complex popliteal variceal recurrence, although the success rate appears substantially lower than for primary treatment of truncal venous insufficiency.

AB - BACKGROUND: Recurrences after varicose vein treatment occur frequently and represent a significant health and economic problem. In contrast to primary treatments of superficial truncal venous insufficiency, their management is often more difficult. Here we assessed the technical feasibility and early results of endovenous laser ablation (EVLA) for recurrences with stumps or subfascial meandering varices after small saphenous vein (SSV) surgery.METHODS: This single-center retrospective study included 45 consecutive EVLA procedures from July 2019 to December 2021 in 40 patients (19 male, 21 female, mean age 62.8 ± 12.7 years). Patients had clinically relevant recurrent varicose veins after SSV surgery, with clinical, etiologic, anatomic and pathophysiologic (CEAP) classification stage of C2S or higher. We categorized the recurrences morphologically according to duplex sonographic criteria. Ablations were done with a 1470 nanometers laser and dual ring radial fibers and aimed at thermal closure as proximal as possible to the upper inflow. Analyses were performed by descriptive statistics and the Kaplan-Meier method. The primary outcome analyzed was the technical success, defined by thermal occlusion not requiring re-intervention during the observation period. The secondary outcome was the occurrence of postoperative complications.RESULTS: A complex morphology with residual stumps or tortuous venous connections to the popliteal vein was present in 35 cases (77.8%). Immediate technical success at the first postoperative visit after a median of 11 days (interquartile range 8-13 days) was 97.8%. During the follow-up period (median 77 days, interquartile range 13-256 days), 6 limbs (13.3%) required redo EVLA due to symptomatic persistent or newly presenting reflux. The median freedom from re-recurrence was 791 days. Otherwise, no medical or surgical complications requiring specific treatment were observed, particularly no endothermal heat-induced thrombosis (EHIT) or other thrombotic complications, and no nerve damage.CONCLUSION: According to our pilot data, EVLA is technically feasible for complex popliteal variceal recurrence, although the success rate appears substantially lower than for primary treatment of truncal venous insufficiency.

KW - Humans

KW - Female

KW - Male

KW - Middle Aged

KW - Varicose Veins/surgery

KW - Saphenous Vein/surgery

KW - Laser Therapy/methods

KW - Retrospective Studies

KW - Aged

KW - Recurrence

KW - Treatment Outcome

KW - Endovascular Procedures/methods

KW - Postoperative Complications/etiology

U2 - 10.1371/journal.pone.0310182

DO - 10.1371/journal.pone.0310182

M3 - SCORING: Journal article

C2 - 39392807

VL - 19

SP - e0310182

JO - PLOS ONE

JF - PLOS ONE

SN - 1932-6203

IS - 10

ER -