Endovenous laser ablation in the treatment of patients with superficial vein thrombosis of lower limbs

Background: The study was performed to evaluate the clinical efficacy and feasibility of endovenous laser ablation (EVLA) of saphenous veins in patients with superficial vein thrombosis (SVT) of lower limbs.

Materials/Methods: A retrospective case-control study was performed using clinical and Duplex-sonographic follow-up data from 200 patients(204 lower limbs) with SVT or varicose vein disease (VVD)  treated using a 940-nm laser. Patients were divided into 2 groups (102 limbs in each group)  matched for sex, age, clinical class (CEAP).

I group (main group)  included lower  limbs with SVT. II group (control group) – lower limbs with VVD. Obligatory high ligation of saphenous veins was performed prior to EVLA in both groups. In the main group washout of thrombi from truncal veins with  catheter  was carried out to enable EVLA procedure. Incompetent or/and thrombosed tributaries of truncal veins underwent concomitant  mini-phlebectomy. SVT of great saphenous vein was  observed in 87% (n=93). Small saphenous vein was affected with thrombotic process in 12,3% (n=9). Outcomes included postoperative complications, disease-specific quality of life questionnaire (CIVIQ), and recanalisation rates.

Results: In the  main group  we had 12,7% (n=13)  technical failures related to an inability to washout thrombi in subacute stage of disease. Positive correlation was observed between duration of SVT and feasibility of EVLA(p<0,01, p=0,51).

No statistically significant differences were seen between groups for complications (ecchymosis: 67,6% (n=69) and 69,6% (n=71) p>0,05, paresthesia: 25,5% (n=26) and 21,6% (n=22) p>0,05, wound infections:  6,9%  (n=7) and 4,9% (n=5) p>0,05).

At the 1 year follow-up both groups demonstrated comparable  improvement in CIVIQ scores (p>0,05). Duplex ultrasonography revealed 14 cases (13,7%) of recanalisation in I group and - 15 cases (14,7) in II group (p>0,05).

Conclusions: High ligation of saphenous veins combined with thrombi washout can enable EVLA in patients with acute SVT ( less than 14 days).

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