American Academy of Phlebology Annual Meeting 2010

American Academy of Phlebology Annual Meeting 2010

Endovenous Laser Ablation of Varicose Veins (EVLA) with 1320nm: A Prospective 5 Year Observational Study of Over 900 Intra and Extrafascial Leg Veins

Author(s): Peter Chapman-Smith

Abstract:

Purpose: To study the efficacy and safety of EVLA with 1320nm in the treatment of leg varicose veins.

Methods: Consecutive private clinic patients were assessed including duplex US examination, then treated with 1320nm endovenous laser ablation (EVLA) using tumescent anaesthesia. Concurrent ultrasound guided foam sclerotherapy (UGS) closed distal vessels and all incompetent tributaries. 1-3% STS was the sclerosant used, using Tessari microbubble foam 3:1 with air mixture. A second UGS treatment was done within 7 days. Serial ultrasound was at 1-2 weeks, 1 mth, 6 mths, 1, 3, and 5yrs post treatment. Patient subjective evaluation was recorded at the 12 month checkup. Adverse events were recorded at all US followups. 907 veins were treated, intra and extrafascially. Vein access was by Seldinger technique, with mechanical laser fibre withdrawal at 0.5-1mm/sec. Release of intravascular haematoma with stab incision was common between 4-8 weeks postop.

Results: 559 patients, 842 limbs and 907 vessels were treated with EVLA and UGS. Trunkal veins were GSV 71.3%, SSV 19.5%, and AASV 9.2%. 4 were refluxing medial gastrocnemius veins . 44 were nonstandard veins such as medial accessory, posterior thigh circumflex, extrafascial GSV tributaries, intergemellar, anterolateral thigh circumflex or just below knee GSV vessels. (37 had 3 vessels, 4 had 4 vessels , and 1 had 5 vessels treated with EVLA stat). Most were CEAP 2-4. <8% were CEAP 5-6. There were no severe adverse outcomes:- nil fatalities, nerve injury, burns or DVT. There were 2 cases of pulmonary embolism warfarinised for 3 months successfully. All patients were happy with the treatment outcome. 4.6% had minimal pain, bruising, 1% thrombophlebitis, 3.8% with transient persistent lower leg swelling, 0.8% scotomata, 2.9% transient dysaesthesias, 0.7% benign tongue of thrombus were noted. Foam UGS required an average <2 treatment sessions for closure (range 1-8) of all refluxing

vessels including tiny tributaries < 2mm in diameter , using average 8.7mls of STS foam. 1 asymptomatic 4mm diameter vein required repeat EVLA at 4.5 years (0.001% recurrence). 0.018% required further UGS in the next 5 years for GSV incompetence, but 100% of SSV and AASVs remained closed on US. The SPJ and SFJ closure rate at 5 years was 70%.

Conclusion: All patients felt EVLA was successful, would recommend it to friends, & would have it repeated if required. High closure rates were reported with high safety in the medium term.