Endovenous laser photocoagulation (EVLP) for varicose veins

Abstract

Background and objectives: Untreated varicose veins have significant morbidity and potential mortality. Treatment aims to relieve symptoms, improve appearance, and to prevent deterioration. Current therapeutic options include graduated compression stockings, sclerotherapy, ambulatory phlebectomy, surgical ligation, and stripping. Results of laser photocoagulation of vascular anomalies have been encouraging. Applying these concepts of laser-tissue interactions, we developed a new method of treatment for varicose veins of the lower extremities.

Study design/materials and methods: One hundred and forty-nine patients with 252 varicose greater saphenous veins underwent endovenous laser photocoagulation (EVLP) from January 1996 to January 2000. Subject's age ranged between 23 years 9 months and 80 years 7 months with a mean age of 50 years 8 months. There were 122 females and 27 males. Only patients with primary varicose veins and saphenofemoral reflux documented by Duplex ultrasound were treated. All patients received surgical ligation of the saphenofemoral junction (SFJ). EVLP was performed using the neodymium:yttrium-aluminium-garnet (Nd:YAG) (1,064 nm) laser, delivered with a 600 microm optical fiber. Laser power was set at 10 or 15 W, delivered with a pulse duration of 10 seconds. The outcome was compared before and after EVLP, based on the score of severity of the varicose veins by Hach's classification.

Results: The range of total delivered energy is from 9,200 to 20,100 J. The entire procedure was completed in 95-175 minutes (mean 122.33 minutes) for bilateral procedures, and 65-100 minutes (mean 81.07 minutes) for unilateral procedures. The follow-up period ranged from 12 to 28 months with a mean of 19 months. One hundred and forty-one patients with 244 legs involved (96.8%) demonstrated remarkable improvement (P < 0.05). Common early complications of EVLP are: local paraesthesia of the treated area in 92 legs (36.5%), ecchymosis and dyschromia in 58 legs (23.0%), superficial burn injury in 12 legs (4.8%), superficial phlebitis in four legs (1.6%), and localized hematoma in two legs (0.8%) at 3 weeks post-operatively. The final outcome showed no significant morbidity or mortality. All patients recovered completely.

Conclusions: EVLP is a simple effective treatment modality for varicose veins. This less invasive method can minimize the complications of conventional surgery.