Abstract

Background and Aims: Chronic vein insufficiency of the lower extremities is one of the most common benign diseases. Surgery was the gold standard in the treatment of varicose veins. For several decades, high ligation at the sapheno-femoral junction (SFJ) and stripping of the GSV was the treatment of choice to eradicate the diseased vein. Insufficiency of the small saphenous vein (SSV) is treated in a similar way, by ligation at the sapheno-popliteal junction (SPJ) and stripping. In 1999, the first report on EVLA appeared in the literature. Endovenous laser ablation (EVLA) is a well-established treatment for chronic venous insufficiency. As India is developing country patients with chronic venous insufficiency usually present to clinician in advanced stages, so we must modify the technique accordingly.  We are presenting our experience of EVLA in 50 cases.

Methods and Materials: Fifty patients were treated under spinal anesthesia in single centre by team of radiologist and surgeon over a period of 8 months (Jan   2015- Aug 2015). The greater saphenous vein and lesser saphenous veins treated by EVLA. This is a prospective observational study to determine whether EVLA could be used to treat saphenous veins in chronic venous insufficiency. The indications for treatment was varicosities [ n = 28], leg edema [ n = 9], varicosities and pain [n = 8], varicosities and ulcer [ n= 5]. 7 In 28 patient EVLA was done in both lower limbs and in 22 patients unilateral limb treatment was done. lower 78 greater saphenous veins and 65 lesser   saphenous veins were treated in 50 patients.

Results:  Out of 143 veins single puncture was sufficient in 122 [85%], Two punctures were required in 21 cases [ 15%]. Treatment was successful in 126 venous segments (88%) in first setting, the residual veins were treated in second setting resulting in 100% obliteration. After treatment, ultrasound surveillance within the next few days confirmed that the saphenous veins and tributaries were all occluded. Bruising noted along the course of treated veins. Neuropraxia noted in leg in all the cases for variable period of 2 weeks to 4 months along the course of saphenous vein and sural nerve. There was no late sequel such as persisting induration or fat atrophy.

Conclusion: The greater and lesser saphenous veins can be treated by EVLA in single setting in all the cases without any significant complications. It is safe, cost effective with a comfortable recovery while maintaining minimally invasive treatment.

Keywords: Endovenous LASER, ultrasound, saphenous veins.