Korean J Radiol.  2016 Jun;17(3):364-369. 10.3348/kjr.2016.17.3.364.

Retrograde Endovenous Laser Ablation through Saphenopopliteal Junctional Area for Incompetent Small Saphenous Vein: Comparison with Antegrade Approach

• Kim JS
• Park SW
• Yun IJ
• Hwang JJ
• Lee SA
• Chee HK
• Hwang JH

• KMID: 2451411
• DOI: http://doi.org/10.3348/kjr.2016.17.3.364

Abstract

OBJECTIVE
To evaluate the safety and efficacy of retrograde endovenous laser ablation (EVLA) and to compare it with the conventional antegrade EVLA for incompetent small saphenous vein (SSV).
MATERIALS AND METHODS
Small saphenous vein was cannulated via two approaches under ultrasound-guidance. One method involved puncturing the SSV cranially at mid-calf (the antegrade group). If the antegrade puncture into the SSV failed twice, the other approach for puncture was selected that involved puncturing the SSV toward the ankle (the retrograde group). Patients were evaluated in terms of technical & clinical success, closure rates of the SSV, and complications including pain, bruising, or paresthesia at all follow-up visits.
RESULTS
The 1470 nm endovenous laser was used in all limbs. Technical success was seen in all limbs in both groups (100%). Closure rate in both groups showed about 95%, without significant difference (p = 0.685). Similar linear endovenous energy density was supplied during the EVLA in both groups (p = 0.876). Three frequent complications including bruising, pain, and paresthesia did not show statistical significance between groups (p = 0.465, 0.823, 1.000, respectively). Major complications were absent in both groups.
CONCLUSION
The EVLA for the incompetent SSV using a retrograde approach is safe and effective and should be considered the alternative method if the antegrade access fails due to vasospasm or small SSV diameter.

Keyword

Veins; Lasers; Ultrasound

MeSH Terms

Follow-Up Studies
Humans
Kaplan-Meier Estimate
Laser Therapy/*methods
Saphenous Vein/diagnostic imaging/*surgery
Treatment Outcome
Ultrasonography
Venous Insufficiency/mortality/*surgery

Figure

• 

  Fig. 1 Retrograde access through SSV 2–3 cm distant from saphenopopliteal junction.A. Ultrasound shows saphenopopliteal junction (arrows) and SSV (arrowheads). B. Ultrasound-guided puncture was performed for successful retrograde access (arrows) and saphenopopliteal junction (double arrows). SSV = small saphenous vein

• 

  Fig. 2 Kaplan-Meier survival curve analysis of occlusion rate of incompetent small saphenous vein after endovenous laser ablation (EVLA) through antegrade group (AG) or retrograde group (RG) approach.

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