Endovenous Laser Therapy (EVLT) and Radiofrequency Ablation (RFA) Of the Great Saphenous Vein: Analysis Of Early Efficacy and Complications

Back to 33rd Annual Symposium
Back to Final Program

alessandra puggioni, MD, michele carmo, MD, manju kalra, mbbs, geza mozes, md, peter gloviczki, md.
Mayo Clinic, Rochester, MN, USA.

BACKGROUND:
EVLT and RFA are new minimally invasive percutaneous endovenous techniques for ablation of the incompetent great saphenous vein (GSV). To evaluate early results, we reviewed saphenous closure rates and complications of both procedures.
METHODS:
Between June 1st 2001 and June 25th 2004, endovenous GSV ablation was performed on 130 limbs in 92 patients: EVLT in 77, and RFA in 53; 124 limbs were C2-C4, and 6 were C5-C6. Concomitant procedures included avulsion phlebectomy in 126 limbs, SEPS in 10, small saphenous ablation in 4 (EVLT in 1, ligation in 1, stripping in 2). Early duplex follow-up was obtained in 65 limbs within 1 month from surgery at a median of 7 days.
RESULTS:
Occlusion of the GSV was confirmed in 93.9% of limbs studied (94.4 % in the EVLT 51/54, and 90.9% in the VNUS group 10/11, p=0.53). The distance between GSV thrombus and the common femoral vein (CFV) ranged from -20 mm (extension into the CFV) to 50 mm, median 9.5 mm, and was similar between the two groups (median 9 mm vs. 10 mm, p=0.22). Thrombus extended into the lumen of the CFV in 3 limbs after EVLT (2.3%), but not in the RFA group (p=0.27). All 3 patients were treated with anticoagulation; one required a temporary IVC filter because of a floating thrombus in the CFV. Duplex follow-up of these 3 patients performed at 12, 14 and 95 days respectively showed complete resolution of the thrombi. No cases of pulmonary embolism occurred.. There was a trend towards more proximal extension of GSV thrombus in older patients (p=0.076). Overall complication rate was 15.4% (20.8 % in the EVLT and 7.6 % in the VNUS group, p=0.0487) and included urinary retention in 1, superficial thrombophlebitis in 4, excessive pain in 6 (3 in the RFA group), hematoma in 1, edema in 3 (one in the RFA group), cellulitis in 2. Except for 2 of the 3 patients with thrombus extension into the CFV, none of these adverse effects required hospitalization.
CONCLUSIONS:
GSV occlusion after endovenous ablation is achieved in over 90% of cases after both EVLT and RFA at one month. In our series 3 cases of thrombus extension into the CFV were observed after EVLT. These findings warrant early duplex scanning in all patients after endovenous procedures. Long-term follow-up with comparison to standard GSV stripping is required to confirm the durability of these endovenous procedures.