Abstract
Purpose
To investigate the value of endovenous laser ablation (ELA) and concomitant ultrasound-guided foam sclerotherapy (USGFS) in patients with chronic venous insufficiency.
Methods
During a 6-year period, concomitant USGFS of the varicose veins were performed in 504 out of 610 patients who underwent ELA for truncal or perforating vein insufficiency. In these 504 patients (944 legs; bilateral in 440 patients), the incompetent veins were greater saphenous vein in 615 legs, small saphenous vein in 118 veins, perforating veins in 42 legs, and a combination of these in 169 legs. In all patients, after ELA of the incompetent veins, USGFS was performed for the remaining varicosities with 1–3% polidocanol foam. Patients were followed up clinically and with color Doppler ultrasound at 1, 6, and 12 months.
Results
ELA was technically successful in all cases, although another venous puncture was necessary in 29 legs. Concomitant USGFS was also technically successful in all cases, but one to three additional sclerotherapy sessions were performed in 203 legs with persistent varicosities. During the follow-up, recanalization of the laser-ablated refluxing veins occurred in 16 legs (1.7%) and was treated with repeat ELA or USGFS. Major complications occurred in 1.4% of the treated legs and included skin necrosis and calf vein thrombosis.
Conclusion
ELA and concomitant foam sclerotherapy is feasible and effective. The procedures are associated with a low complication rate and can be performed in both legs in the same session. Concomitant use of laser and foam may potentially decrease the recanalization rate of laser-ablated vessels.
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References
Min RJ, Khilnani NM (2005) Endovenous laser ablation of varicose veins. J Cardiovasc Surg 46:395–405
Yilmaz S, Ceken K, Alparslan A et al (2007) Endovenous laser ablation for saphenous vein insufficiency: immediate and short-term results of our first 60 procedures. Diagn Interv Radiol 13:156–163
Fernández CF, Roizental M, Carvallo J (2008) Combined endovenous laser therapy and microphlebectomy in the treatment of varicose veins: efficacy and complications of a large single-center experience. J Vasc Surg 48:947–952
Coleridge Smith P (2009) Sclerotherapy and foam sclerotherapy for varicose veins. Phlebology 24:260–269
King T, Coulomb G, Goldman A et al (2009) Experience with concomitant ultrasound-guided foam sclerotherapy and endovenous laser treatment in chronic venous disorder and its influence on health related quality of life: interim analysis of more than 1000 consecutive procedures. Int Angiol 28:289–297
Park SW, Yun IJ, Hwang JJ et al (2009) Fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter in varicose tributaries followed by endovenous laser treatment of incompetent saphenous veins: technical feasibility and early results. Dermatol Surg 35:804–812
Jung IM, Min SI, Heo SC et al (2008) Combined endovenous laser treatment and ambulatory phlebectomy for the treatment of saphenous vein incompetence. Phlebology 23:172–177
Vuylsteke M, Liekens K, Moons P et al (2008) Endovenous laser treatment of saphenous vein reflux: how much energy do we need to prevent recanalizations? Vasc Endovascular Surg 42:141–149
Proebstle TM, Krummenauer F, Gül D et al (2004) Nonocclusion and early reopening of the great saphenous vein after endovenous laser treatment is fluence dependent. Dermatol Surg 30:174–178
Proebstle TM, Gül D, Lehr HA et al (2003) Infrequent early recanalization of greater saphenous vein after endovenous laser treatment. J Vasc Surg 38:511–516
Proebstle TM, Moehler T, Herdemann S (2006) Reduced recanalization rates of the great saphenous vein after endovenous laser treatment with increased energy dosing: definition of a threshold for the endovenous fluence equivalent. J Vasc Surg 44:834–839
van Neer P, Kessels FG, Estourgie RJ et al (2009) Persistent reflux below the knee after stripping of the great saphenous vein. J Vasc Surg 50:831–834
Theivacumar NS, Darwood RJ, Dellegrammaticas D et al (2009) The clinical significance of below-knee great saphenous vein reflux following endovenous laser ablation of above-knee great saphenous vein. Phlebology 24:17–20
Theivacumar NS, Dellagrammaticas D, Mavor AI et al (2008) Endovenous laser ablation: does standard above-knee great saphenous vein ablation provide optimum results in patients with both above- and below-knee reflux? A randomized controlled trial. J Vasc Surg 48:173–178
Van Den Bos RR, Neumann M, De Roos KP et al (2009) Endovenous laser ablation—induced complications: review of the literature and new cases. Dermatol Surg 35:1206–1214
Marsh P, Price BA, Holdstock J et al (2010) Deep vein thrombosis (DVT) after venous thermoablation techniques: rates of endovenous heat-induced thrombosis (EHIT) and classical DVT after radiofrequency and endovenous laser ablation in a single centre. Eur J Vasc Endovasc Surg 40:521–527
Acknowledgment
We thank the Akdeniz University Scientific Research Projects Unit for supporting this study.
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The authors declare that they have no conflict of interest.
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Yilmaz, S., Ceken, K., Alparslan, A. et al. Endovenous Laser Ablation and Concomitant Foam Sclerotherapy: Experience in 504 Patients. Cardiovasc Intervent Radiol 35, 1403–1407 (2012). https://doi.org/10.1007/s00270-011-0329-1
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DOI: https://doi.org/10.1007/s00270-011-0329-1