Feasibility and technique of endovenous laser ablation (EVLA) of recurrent varicose veins deriving from the sapheno-femoral junction—A case series of 35 consecutive procedures

Aim To assess the feasibility and technical success of endovenous laser ablation (EVLA) of recurrent varicose veins arising from the former sapheno-femoral junction (SFJ). Methods We retrospectively analyzed all EVLA procedures treated in our institution by one surgeon between March 2019 and April 2...

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Published in:	PloS one 2020-07, Vol.15 (7), p.e0235656-e0235656
Main Authors:	Müller, Lars, Alm, Jens, Chen, Robert Jeenchen
Format:	Article
Language:	eng
Subjects:	Ablation Ablation (Vaporization technology) Biology and Life Sciences Cannulation Care and treatment Catheters Complications Diseases Engineering and Technology Feasibility studies Femur Fiber lasers Laser ablation Lasers Medicine and Health Sciences Morphology Patient outcomes Recurrence (Disease) Refluxing Relapse Research and Analysis Methods Shutdowns Subgroups Thromboembolism Thrombosis Tributaries Ultrasonic imaging Ultrasound Varicose veins Vascular surgery Vascularization
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Summary:	Aim To assess the feasibility and technical success of endovenous laser ablation (EVLA) of recurrent varicose veins arising from the former sapheno-femoral junction (SFJ). Methods We retrospectively analyzed all EVLA procedures treated in our institution by one surgeon between March 2019 and April 2020 and selected all consecutive cases with SFJ recurrence occuring after surgical high ligation and stripping or endovenous thermal ablation for incompetence of the great saphenous vein (GSV) in superficial venous insufficiency. The feasibility, technical success as determined by duplex ultrasound on the postoperative visit, complications and rate of endothermal heat-induced thrombosis (EHIT) were recorded. A subgroup definition was performed based on sonographic morphology of the recurrence and resulting strategy of ablation. Results Thirty-five limbs with SFJ recurrence in 34 patients were treated with EVLA in order to shut down the highest refluxing point. In 22 interventions, it was required to switch off a short stump or a neovascularization by direct puncture (Subgroup 1). In 13 treatments, the presence of residual GSV segments, or persistent, varicose transformed major tributaries like the anterior accessory great saphenous vein, enabled cannulation and advancing the laser fiber from distal to the former SFJ (Subgroup 2). The EVLA procedures could be successfully carried out in all 35 cases. There were no major complications, no thromboembolism or EHIT, and no local groin complications. In one case, the patient developed a phlebitic response that required temporary medication. Technical success was achieved with 34/35 treatments (97.1%). When comparing the subgroups, the morphological pattern of the SFJ recurrence and the resulting technique of puncture, cannulation and ablation did not influence the result. Conclusions The results of this case series suggest that SFJ recurrences can also be successfully treated in situations where there are tortuous or short stumps that require direct puncture and ablation.
ISSN:	1932-6203 1932-6203