Endovenous laser ablation of varicose veins of lower extremities of different diameters

Objective. To evaluate the effect of increased diameter of varicose veins of the lower extremities on the recurrence rate after endovenous laser ablation (EVLA) in the long-term postoperative period.

Materials and methods. A prospective study included 65 patients who underwent 71 EVLA procedures. All patients signed informed consent to participate in the study. The procedure was performed using a Biolitec Ceralas E15 ELVeS device (wavelength 1470 nm, power 10-15 W) under tumescent anesthesia. The patients were divided into two groups: group 1 – vein diameter ≤10 mm (27 patients), group 2 – vein diameter >10 mm (38 patients). The follow-up period ranged from 28 to 1674 days (median 336 days).

Results. Primary obliteration success was achieved in 100% of cases in both groups. After 1 year, occlusion was maintained in 96.3% of patients in group 1 and 94.7% in group 2. No significant difference in recurrence rate was found between the groups (χ²=0.03; p=0.86), indicating the effectiveness of EVLA for varicose veins of the lower extremities of different diameters. The median energy delivered was 1198 J in group 1 and 1802 J in group 2 (U=340; p=0.013). A strong positive correlation was found between the energy delivered and the vein diameter (r_s=0.814; р<0.001). The main cause of recurrence was accessory trunks of the great saphenous vein. In one case (20% of recurrences in group 2) recurrence was associated with a history of thrombophlebitis.

Conclusion. EVLA is effective for varicose veins of the lower extremities of different diameters, however for veins >10 mm significantly higher energy is required. Thorough preoperative assessment of accessory veins is necessary to reduce the risk of recurrence. A past thrombophlebitis may affect vein coagulation and be one of the causes of recanalization, which should be taken into account when planning surgery.

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