Efficacy and Safety of Endovenous Laser Ablation in Very Large and Tortuous Great Saphenous Veins

Purpose: To investigate the efficacy and safety of endovenous laser ablation (EVLA) with high energy delivery in large great saphenous veins (GSVs) at 1-year sonographic follow-up. Materials and Methods: Retrospective review of 385 patients who underwent EVLA between August 2011 and September 2013 was conducted, and 44 consecutive patients (21 women [47%1; mean age, 41 y; range, 23-66 y) With 49 large GSVs were included. Vein size and clinical follow-up results were recorded. A 600-mu m bare-tipped 1,470-nm laser fiber was used for the EVLA procedure. Intended energy delivery was 150 J/cm (10 sessions at 15 W) for proximal GSV segments less than 20 mm in diameter and 195 J/cm (13 sessions at 15 W) for larger veins. Improvements in clinical and quality-of-life scores at 6 months were assessed with three validated scoring systems. Results: Mean GSV diameter was 16.9.5 mm (range, 15-26 ram). Five patients had GSVs at least 20 mm in diameter. Technical success was observed in 48 GSVs (97.9%) at 1-month follow-up. A second EVLA treatment was performed in one case and achieved closure, for a GSV occlusion rate of 100% at 6 months. All patients showed significant clinical improvement on all three scoring systems (P<.001). One-year follow-up was completed in 48 of 49 cases (98%). No reeanalization was observed at 1-year follow-up, and there were no major complications. Conclusions: Sonographic follow-up at 1 year shows that EVLA is an effective and safe procedure with excellent technical success rates in the treatment of large GSVs.