Cor Vasa 2017, 59(6):e525-e529 | DOI: 10.1016/j.crvasa.2016.11.002

Catheter-based endovenous laser ablation of saphenous veins in the treatment of symptomatic venous reflux: Early results

Tomáš Honěk^a,c,*, Martin Horváth^a,c, Vojtěch Horváth^a,b, Marek Šlais^a,b, Tomáš Kneifl^a, Jakub Honěk^a,c, Andrea Havlínová^a, Miroslav Vítovec^a,d, Vratislav Fabián^a,e, Petr Slovák^a,e

^a Avicena - chirurgie, s.r.o., Praha, Česká republika

^b Oddělení cévní chirurgie, Nemocnice Na Homolce, Praha, Česká republika

^c Kardiologická klinika, 2. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Motole, Praha, Česká republika

^d Medivican Praha, s.r.o., Praha, Česká republika

^e Katedra fyziky, Fakulta elektrotechnická, České vysoké učení technické v Praze, Praha, Česká republika

Introduction: Catheter-based endovenous laser ablation (EVLA) is a widely used alternative to surgery and is slowly becoming a state of the art method in the treatment of varicose veins. In this observational study we sought to determine whether the method is safe and feasible in an unselected population of patients and if it can be used on more vein segments during one procedure.

Methods and results: From February 2010 to March 2016 EVLA was performed in 1209 venous segments in 1117 consecutive patients (74% women) with venous reflux. Mean diameter of ablated segments was 9.3 mm (range 5-25 mm). All procedures were performed on an out-patient basis using local tumescent anesthesia. Intraoperative sonographic guidance was mandatory. Early closure was successful in 98.8% of treated venous segments. Early non-closure occurred in 9 patients (15 treated segments) and all were successfully resolved by early re-EVLA. The causes of incomplete closure were mainly of technical character due to the learning period - low energy, non-closure of proximal tributaries, non-complete emptying of the vein during procedure. Non-closure was not related to diameter of the vein. In 6 patients the prolapse of the thrombus into the lumen of deep femoral vein was noted. The thrombus resolved after one week treatment with low molecular weight heparin. Low-risk pulmonary embolism was observed in one non-compliant patient.

Conclusion: EVLA of the greater saphenous vein, small saphenous vein and large tributaries in the treatment of symptomatic reflux is a flexible, safe, effective and reproducible method. The closure of venous segments was performed without limitation in venous diameter and amount of segments.

Keywords: Chronic venous insufficiency; Endovenous laser ablation; Minimally invasive treatment

Received: May 3, 2016; Revised: October 27, 2016; Accepted: November 3, 2016; Published: December 1, 2017  Show citation