Endovenous Laser Treatment (EVLT) with High Ligation of Small Saphenous Vein Varicosities

Min, Seung Kee; Jung, In Mok; Min, Sang Il; Heo, Seung Chul; Ahn, Young Joon; Hwang, Ki Tae; Park, Yang Jin; Lee, Taeseung; Ha, Jongwon; Kim, Sang Joon; Chung, Jung Kee

Abstract

PURPOSE: Endovenous laser treatment (EVLT) of great saphenous vein (GSV) varicosities is a widely accepted procedure. However, EVLT of small saphenous vein (SSV) varicosities is not so popular due to concern about sural nerve damage and popliteal thrombosis. In addition, higher rates of recanalization and recurrence of tributaries make clinicians reluctant to use EVLT for SSV incompetence. The purpose of this study is to assess the safety and efficacy of SSV EVLT and the advantage of a combined high ligation and EVLT to reduce the complications and recurrence. METHOD: Between November 2003 and March 2006, 47 patients (55 limbs) with SSV incompetence and enlarged truncal varicosities, documented by duplex ultrasound, were included in the study. All patients were treated with an EVLT combined with ambulatory phlebectomy (AP) of the residual varicosities. High ligation of the sapheno-popliteal junction (SPJ) was performed in 26 limbs (47.3%, HL group); the EVLT without high ligation was performed in another 29 limbs (52.7%, NHL group). The patients were followed by clinical examinations at 1 week, 4 weeks and 12 weeks and with duplex ultrasound at 12 weeks after the operation. Symptomatic improvement, complications, recanalization of the SSV and recurrence of tributaries were recorded and compared between the two groups. RESULT: Mean follow-up was for 5.0 months. Most of the patients (95.4%) showed symptomatic improvement at 12 weeks with better venous clinical severity scores (VCSS). The overall complication rate was 27.3% (15 limbs), most of them were minor problems including 4 cases of transient sural nerve numbness (7.3%). The duplex US-confirmed saphenous vein recanalization rate and recurrence rate of tributaries at 3 months were 5.4% and 9.1%, respectively. There were no differences in the rate of symptomatic improvement and complications between the HL and NHL groups. However, the HL group showed a lower tendency for recanalization and recurrence compared to the NHL group.
CONCLUSION
EVLT combined with AP might be an effective minimally invasive treatment modality for SSV varicosities with an acceptable complication rate and low recanalization rate of the saphenous veins. The simultaneous high ligation of the SPJ decreased the rates of recanalization and recurrence. Long-term data from large randomized prospective trials with more objective measure of the outcomes are needed to confirm the effectiveness and durability of this operative procedure.