Endovenous Laser Treatment (EVLT) Combined with Stab Phlebectomy (SP) for Lower Extremity Varicose Veins

Jung, In Mok; Chung, Jung Kee; Chai, Young Joon; Heo, Seung Chul; Ahn, Young Joon; Hwang, Kee Tae; Ha, Jongwon; Kim, Sang Joon

Abstract

PURPOSE
For the treatment of residual visible tributaries following minimally invasive saphenous vein ablation procedures such as endovenous laser treatment (EVLT) and radiofrequency ablation (RF), a variety of options including observation, sclerotherapy, ultrasonography-guided sclerotherapy, stab phlebectomy (SP) and additional laser therapy have been developed. We performed endovenous laser treatment combined with stab phlebectomy and we evaluated the early results to assess the efficacy and safety of this procedure.
METHODS
Between February 2003 and February 2006, one hundred twelve venous insufficiencies of the lower limbs in 106 patients (46 men and 60 women; mean age: 51.7 years) were treated with EVLT combined with SP. According to the CEAP classification, 103 limbs were C2, and nine were C3/C4. 810-nm diode laser energy was delivered percutaneously into the saphenous veins (86 GSVs, 20 SSVs, 6 GSV+SSVs). All patients were followed up on an outpatient basis and duplex ultrasonography (US) was performed 3 months after operation.
RESULTS
The mean follow-up period was 2.92 months. All the patients had symptomatic improvement and immediately returned to normal daily activities. The overall complication rate was 36.6% (41 cases), and most of them were minor problems including ecchymosis in 22, paresthesia in 8, induration in 5 and excessive pain in 2. Three cases of cellulitis or thrombophlebitis were present and this resolved with drainage and antibiotics. One case of foot drop developed, but this improved with active physiotherapy within a few months. No postprocedural symptomatic deep vein thrombosis occurred. The recurrence rate of tributaries at 3 months was 13.6%, but these were easily controlled by sclerotherapy if needed. The duplex US-confirmed saphenous vein recanalization rate at 3 months was 5.9%.
CONCLUSION
EVLT combined with SP could be a novel minimally invasive modality for treating lower extremity varicose veins with an acceptable complication rate and a low recanalization rate of the saphenous veins. It could lessen the possibility of additional treatments for the residual visible tributaries and so improve the satisfaction index, along with the cosmetic and economic advantages. However, long-term follow up and postoperative duplex US with an additional objective index examination are required to confirm the effectiveness and durability of this operative procedure.