American Academy of Phlebology Annual Meeting 2010
Endovenous Laser Ablation of Varicose Veins (EVLA) with
1320nm: A Prospective 5 Year Observational Study of Over
900 Intra and Extrafascial Leg Veins
Author(s): Peter Chapman-Smith
Abstract:
Purpose: To study the efficacy and safety of EVLA with 1320nm in the treatment of leg varicose
veins.
Methods: Consecutive private clinic patients were assessed including duplex US examination,
then treated with 1320nm endovenous laser ablation (EVLA) using tumescent anaesthesia.
Concurrent ultrasound guided foam sclerotherapy (UGS) closed distal vessels and all
incompetent tributaries. 1-3% STS was the sclerosant used, using Tessari microbubble foam 3:1
with air mixture. A second UGS treatment was done within 7 days. Serial ultrasound was at 1-2
weeks, 1 mth, 6 mths, 1, 3, and 5yrs post treatment. Patient subjective evaluation was recorded at
the 12 month checkup. Adverse events were recorded at all US followups. 907 veins were
treated, intra and extrafascially. Vein access was by Seldinger technique, with mechanical laser
fibre withdrawal at 0.5-1mm/sec. Release of intravascular haematoma with stab incision was
common between 4-8 weeks postop.
Results: 559 patients, 842 limbs and 907 vessels were treated with EVLA and UGS. Trunkal
veins were GSV 71.3%, SSV 19.5%, and AASV 9.2%. 4 were refluxing medial gastrocnemius
veins . 44 were nonstandard veins such as medial accessory, posterior thigh circumflex,
extrafascial GSV tributaries, intergemellar, anterolateral thigh circumflex or just below knee
GSV vessels. (37 had 3 vessels, 4 had 4 vessels , and 1 had 5 vessels treated with EVLA stat).
Most were CEAP 2-4. <8% were CEAP 5-6. There were no severe adverse outcomes:- nil
fatalities, nerve injury, burns or DVT. There were 2 cases of pulmonary embolism warfarinised
for 3 months successfully. All patients were happy with the treatment outcome. 4.6% had
minimal pain, bruising, 1% thrombophlebitis, 3.8% with transient persistent lower leg swelling,
0.8% scotomata, 2.9% transient dysaesthesias, 0.7% benign tongue of thrombus were noted.
Foam UGS required an average <2 treatment sessions for closure (range 1-8) of all refluxing
vessels including tiny tributaries < 2mm in diameter , using average 8.7mls of STS foam. 1
asymptomatic 4mm diameter vein required repeat EVLA at 4.5 years (0.001% recurrence).
0.018% required further UGS in the next 5 years for GSV incompetence, but 100% of SSV and
AASVs remained closed on US. The SPJ and SFJ closure rate at 5 years was 70%.
Conclusion: All patients felt EVLA was successful, would recommend it to friends, & would
have it repeated if required. High closure rates were reported with high safety in the medium
term.
Categories
• Advances in Endovenous Ablation
7140-0197 Rev. A