Endovenous laser ablation (EVLA) to treat recurrent varicose veins

Abstract

Objectives: This cohort study assesses the effectiveness and safety of endovenous laser ablation (EVLA) in the management of recurrent varicose veins (RVVS).

Method: 104 limbs (95 patients) undergoing EVLA for RVVS were grouped according to pattern of reflux. For patients with recurrent SFJ/great saphenous vein (GSV) (Group GR) and SPJ/small saphenous vein (SSV) (Group SR) varicosities ablation rates and QoL (Aberdeen Varicose Vein Severity Scores (AVVSS)) were compared with those for age/sex matched patients undergoing EVLA for primary GSV/SSV dependent varicose veins (Groups GP and SP).

Results: In patients with RVVS the axial vein was ablated in 102/104 (98%) limbs whilst 2 GSVs (group GR) partially recanalised by 3 months (GSV ablated in 49/51 (96%) limbs versus 50/51 (98%) limbs in GP [p = 0.2]). Improvements in AVVSS at 3 months (median GR: 14.2 (inter-quartile range (IQR) 10.2-18.9) to 3.2(1.2-6.4), p < 0.001; GP: median 15.9(IQR 11.4-22.7) to 3.8(1.1-5.6), p < 0.001, Mann-Whitney u-test) were similar (78% versus 76%, p = 0.23). The SSV was ablated in 24/24 limbs in groups SR and SP and the % improvement in AVVSS was 83% (median 14.4 (IQR 8.2-19.4) to 2.4 (1.9-4.6), p < 0.001, Mann-Whitney u-test) and 84% (median 13.8 (IQR 6.3-17.5) to 2.2 (1.2-5.1), p < 0.001) respectively (p = 0.33). These improvements persisted at 1 year follow-up. A further 29 limbs with isolated anterior accessory great saphenous vein (AAGSV) or segmental GSV/SSV reflux were successfully ablated. Complication rates for primary and RVVS were similar.

Conclusions: EVLA is a safe and effective option for the treatment of RVVS and could be a preferred option for suitable patients.