1. Endo-venous Laser Ablation in recurrent Great saphenous Reflux; A single unit experience
Introduction
Methods
Results
Conclusions
Recurrence rate of symptomatic varicose veins after Sapheno-Femoral Ligation and stripping has been reported to be up to 60% after 10 years follow up(1,2). Recurrence rates are even higher for SFL only without stripping of the Great Saphenous Vein (GSV). Re-do surgery for varicose veins caused by Recurrent Great Saphenous Reflux (RGSR) is technically challenging and associated with higher complication rates (3).
A total of 928 legs in 671 patients were treated with EVLA. This comprised: Group-1; 198/928 (21%) and Group-2; 730/928 (79%). Follow up was complete in 665 patients (928 legs) with those who could not be followed up being overseas. Mean post-procedure day-01 pain scores were comparable in both groups and not significantly different in unilateral / bilateral procedure. There were two cases of partial thrombi extending in to the femoral vein (Group-2), during follow up scanning and were successfully treated by anti-coagulation and stockings. Symptomatic thigh bruising was seen (Group-1, 24%) and (Group-2, 21%), p=>0.05. Mean time to return to full functionality was 2 days in unilateral and 3 days in bilateral treatments in both groups (p=>0.05). One patient with partial recanalization of the GSV (Group-2) after 9 months required foam ablation.
A Prospective comparative analysis of EVLA in RGSR (Group-1) and Primary Great Saphenous Reflux (PGSR); (Group-2) was carried out to compare the acceptability and efficacy of EVLA in RGSR. The study period was from January 2012 to January 2015.
All limbs scanned and the diagnosis confirmed by duplex imaging performed by a single operator. Mean follow up was 18 (6-42) months. The groups were compared for post-procedure pain on day 01 (visual analog scale) and time taken to return to full functionality. All non-truncal varicosities were treated by a combination of micro-stab avulsion and sclerotherapy in the same sitting. The mode of anaesthesia was either local anaesthetic supplemented by sedation or spinal anaesthesia, based on patient preference. Those with bilateral disease were treated simultaneously unless by patient request. Routine duplex imaging was done at 1, 2 and 4 weeks post-operative and as required thereafter.
EVLA is safe and effective for treatment of RGSR with comparable results to PGSR.
The post-operative pain and time taken to return to full functionality did not show any significant change compared to EVLA in PGSR. Although a direct comparison against re-do surgery could not be carried out due to a shift in treatment paradigms from surgery to laser, the results were very encouraging. Longer term follow up will be required to assess the re-recurrence rates after EVLA.
Objectives
References
In an era where endovenous ablation has largely displaced surgery in the treatment of varicose veins, we studied the place of Endo-Venous Laser Ablation (EVLA) and its efficacy in treating recurrence of symptomatic varicose veins due to RGSR.
Dwerryhouse S, Davies B, Harradine K, Earnshaw JJ. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial. J Vasc Surg 1999;29:589-92
Gad MA, Saber A, Hokkam EN. Assessment of Causes and Patterns of Recurrent Varicose Veins After Surgery. North American Journal of Medical Sciences. 2012;4(1):45-48
Groenendael LV et al. Treatment of recurrent varicose veins of the great saphenous vein by conventional surgery and endovenous laser ablation, J. Vascular Surgery 2009; 50:5:
Theivakumar NS, Gough MJ. Endovenous Laser Ablation (EVLA) to treat recurrent varicose veins. Eur J Vasc Endovasc Surg. 2011 May;41(5):691-6