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Endovenous Laser Treatment Addresses Varicose Veins Caused by Non-Great Saphenous Vein Reflux: Presented at SIR

By Paula Moyer

NEW ORLEANS, LA -- April 6, 2005 -- Patients with varicose veins often have reflux in veins other than the great saphenous vein (GSV), and those varicosities are highly responsive to endovenous laser ablation, according to findings presented here April 4^th at the 30^th annual meeting of the Society of Interventional Radiology.

"This is the first large study that shows endovenous laser ablation is highly effective at treating an under-recognized but common cause of varicose veins," said principal investigator Robert J. Min, MD, MBA, director of vascular surgery at Weill Medical College of Cornell University in New York, New York, United States. "This treatment is effective and extremely safe and well tolerated with only local anaesthesia."

An effective treatment of non-GSV varicosities is important because most patients are symptomatic, he said. They complain of fatigue, leg heaviness, and aching leg pain, and the condition can progress to skin ulceration or bleeding. The condition has to be diagnosed with ultrasound, Dr. Min said.

Among conventional therapies, surgery has a recurrence rate of greater than 25%, and ultrasound-guided therapy is burdened with an accuracy issue, he said, so that sclerosis occurs in unintended targets and has a recurrence rate of greater than 50%.

The investigators conducted the study to determine whether endovenous laser treatment was a safe way to address reflux of the anterior accessory great saphenous vein (AGSV), small saphenous vein (SSV), and posterior thigh circumflex vein (PTC).

Over a 56-month period, Dr. Min and colleagues treated 204 limbs in 192 subjects who had varicose veins that were not attributable to GSV reflux. The procedures involved 810-nanometre (nm) diode laser energy (Diomed, Inc., Andover, Massachusetts). The laser energy was delivered endovenously by a 600-Mu fibre.

A total of 104 limbs underwent treatment of the AGSV; the treating physicians also treated the SSV in 86 limbs and the PTC in 14 limbs. The patients received tumescent anesthesia consisting of 100 to 300 mL of lidocaine 0.1%, delivered perivenously under sonographic guidance.

Dr. Min pointed out that the tumescent anesthesia provided for compression, ensured circumferential contact between the laser fiber and the vein wall, and allowed a fluid barrier to protect the adjacent tissues from thermal damage.

To assess the treatment's effectiveness and document adverse reactions, the treating physicians evaluated the patients clinically and with diagnostic ultrasound at 1 month after the initiation of treatment, after treatment was completed, and yearly thereafter. Patients who had any problematic tributary varicosities or telangiectasia at follow-up were treated with compression sclerotherapy.

The investigators defined successful occlusion as the absence of flow on color Doppler.

After an average follow-up of 24 months and an upward range of 53 months, the procedure was categorized as successful in 97% of limbs in which the AGSV was treated, 97% of those in which the SSV was treated, and 93% of the limbs in which the PTC was treated.

In six of the seven procedures that failed, the failure occurred before 6 months lapsed. Therefore, these failures may have been due to inadequate treatment rather than true recurrences. All patients subsequently underwent successful retreatment with endovenous laser.

In 161 veins that were treated with 14 watts, one failure occurred; no failures have occurred when physicians used more than 70 joules/cm. In 96% of 96 procedures that involved treatment of veins other than the non-GSV and for which the investigators have 2-year data, the veins have remained closed.

The investigators documented no skin burns, paresthesias, deep vein thromboses or other heat-related complications.

The procedure was well tolerated by all subjects who received strictly local anaesthesia, with no need for sedation, regional anesthesia, or general anesthesia, Dr. Min said. He attributed the reliance on only a local block to the use of tumescent anesthesia.


[Presentation title: Endovenous Laser Ablation of Non-Great Saphenous Vein Truncal Reflux. Abstract 142]

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