Prospective Evaluation of Higher Energy Great Saphenous Vein Endovenous Laser Treatment

Abstract

In this study, the hypothesis that higher energy dose improves procedural success without increasing complications was prospectively evaluated by performing endovenous laser therapy (ELT) at energies greater than 80 J/cm. One hundred consecutive great saphenous (GSV), anterior accessory great saphenous (AAGSV), or posterior accessory great saphenous (PAGSV) veins were treated with the intent to deliver an energy dose of greater than 80 J/cm. Eighty-one patients (64 women, 17 men) were treated. Mean age was 49 years (range, 25–77 years; SD, 12 years). Ultrasound (US) and clinical follow-up was performed at 1 week, 3, 6, 9, and 12 months until all veins had at least 3 months of follow-up. Success was defined as absence of reflux throughout the entire treated segment on follow-up US and clinical resolution of symptoms. Incomplete vein ablation was defined as US evidence of flow in a segment of a treated vein at any point during the follow-up period. One hundred veins were treated with an average energy of 95 J/cm (range, 57–145 J/cm; SD, 16 J/cm). Follow-up and success at 1 week was 100%. Four veins could not be followed up beyond 1 week. Of the 96 remaining veins all had 3 months follow-up with an average follow-up of 9 months (range, 3–13 months; SD, 4 months). There were five failures and 91 successes for a success rate of 95%. Four of the treatment successes demonstrated segmental patency but no reflux on US for a complete vein ablation rate of 91%. No major complications occurred. The treatment failures occurred at an average energy dose of 98 J/cm. Two of the three failures were AAGSVs, one was a GSV ipsilateral to one of the failed AAGSVs, and two were bilateral GSVs treated during the same procedure. Average body mass index (BMI) was 30 for the successes and 46 for the failures. This difference was statistically significant (P = .0009). The mean length of the failed treatments from the saphenofemoral junction to their termination into a varicose tributary was 10.9 (range, 8–15 cm; SD, 3.7 cm). This was significantly less than the length of the successful treatments (P = .000003). Higher energy GSV ELT is safe and highly successful.