Expanding the role of Endovenous Laser Ablation (EVLT): Early Results in Large Diameter, Small Saphenous and Anterior Accessory Veins

OBJECTIVES: EVLT ablates axial veins for symptomatic reflux but there is debate regarding its efficacy and complications in large veins (≥1cm). EVLT of small saphenous (SSV)and anterior accessory veins (AAV) has not been well-characterized.
METHODS: Retrospective review of EVLT in great saphenous (GSV), SSV or AAV from 8-1-2007 to 5-07-2009. 885 limbs were reviewed. 153 were excluded for incomplete information. Gender, age, vein size, operative details, ultrasound and clinical follow-up were recorded. Vein diameter <1 cm was considered small, veins ≥ 1 cm at any point were considered large. Students t test compared continuous variables and Chi square compared nominal variables. P value ≤ .05 was significant.
RESULTS: 732 ablations were reviewed; 175 men, 557 women (76.1%). Average follow-up was 3.0 weeks. All patients had at least 1 post-procedure ultrasound. 565 GSV(77.3%), 113 SSV (15.4%) and 53 AAV (7.2%) were treated. 88 EVLT were performed on veins ≥ 1 cm, 12% of all treated veins. GSV were 93.2% of treated large veins (P=<.001 vs entire cohort). 4.9% of small vein and 9.1% of large vein limbs had active ulceration (P=.11). An average of 2983 joules (range 250-7922) was used per EVLT, with veins ≥ 1 cm being treated with significantly more energy (3733 vs. 2876 joules, P <.001). Complications occurred in 7.61% of small vein and 7.95% of large vein ablations (P =NS). EVLT failures of closure were 3.4% in small and 4.5% in large veins (P=.NS). In veins of all sizes, GSV had more successful closures than SSV or AAV (P=<.001) and fewer complications (P=.005) (Table).
CONCLUSIONS: Complication and closure rates are not significantly different for veins ≥ 1 cm vs smaller veins. EVLT is a safe and effective large vein closure. Significantly higher failure and complication rates were seen in SSV and AAV treatment vs GSV.