Feasibility and potential significance of prophylactic ablation of the major ascending tributaries in endovenous laser ablation (EVLA) of the great saphenous vein: A case series

Recurrent varicosities after endovascular laser ablation (EVLA) of the great saphenous vein (GSV) are frequently due to varicose transformed, initially unsealed major ascending tributaries of the saphenofemoral junction (SFJ). Preventive ablation of these veins, especially the anterior accessory sap...

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Bibliographic Details
Published in:	PloS one 2021-01, Vol.16 (1), p.e0245275-e0245275
Main Authors:	Müller, Lars, Alm, Jens
Format:	Article
Language:	eng
Subjects:	Ablation Ablation (Surgery) Adult Aged Biology and Life Sciences Blood vessels Cannulation Cardiovascular system Care and treatment Catheters Compression therapy Confluence Engineering and Technology Feasibility Female Humans Laser ablation Laser Therapy - adverse effects Laser Therapy - instrumentation Laser Therapy - methods Lasers Male Medicine and Health Sciences Methods Middle Aged Occlusion Patient outcomes Physical Sciences Postoperative Complications - epidemiology Prophylactic Surgical Procedures - adverse effects Prophylactic Surgical Procedures - instrumentation Prophylactic Surgical Procedures - methods Regression analysis Research and Analysis Methods Saphenous Vein - pathology Saphenous Vein - surgery Success Surgery Thromboembolism Thrombosis Ultrasonic imaging Varicose veins Varicose Veins - prevention & control Varicose Veins - surgery Vascular surgery Veins & arteries
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Summary:	Recurrent varicosities after endovascular laser ablation (EVLA) of the great saphenous vein (GSV) are frequently due to varicose transformed, initially unsealed major ascending tributaries of the saphenofemoral junction (SFJ). Preventive ablation of these veins, especially the anterior accessory saphenous vein, is discussed as an option, along with flush occlusion of the GSV. However, few related data exist to date. A consecutive case series of 278 EVLA procedures of the GSV for primary varicosis in 213 patients between May and December 2019 was retrospectively reviewed. The ablations were performed with a 1470 nm dual-ring radial laser and always included flush occlusion of the GSV, and concomitant ablation of its highest ascending tributaries by additional cannulation and ablation when this seemed anatomically appropriate. The initial technical success, comprising occlusion of the GSV and its major tributaries, was set as the primary endpoint. Possible determinants were explored using downstream multiple logistic regression analysis. The early technical success was 92.8%, with the GSV occluded in 99.6% and the highest ascending SFJ tributary, if present, in 92.4%. Additional ablations of ascending tributaries were performed in 171 cases (61.5%), the latter being associated with success (OR 10.39; 95% CI [3.420-36.15]; p < 0.0001). Presence of anterior as opposed to posterior accessory saphenous vein was another positive predictor (OR 3.959; 95% CI [1.142-13,73]; p = 0.027), while a confluence of the tributary in the immediate proximity to the SFJ had a negative impact (OR 0.2253; 95% CI [0.05456-0.7681]; p = 0.0253). An endothermal heat-induced thrombosis (EHIT) ≥ grade 2 was observed in three cases (1.1%). A co-treatment of the tributaries is feasible and could improve the technical success of EVLA if a prophylactic closure of these veins is desired, especially if their distance to the SFJ is short. Its effect on the recurrence rate needs further research.
ISSN:	1932-6203 1932-6203