Fate of the great saphenous vein following endovenous laser ablation: Does re-canalisation mean recurrence?

Objective: To assess changes in great saphenous vein (GSV) diameter and the significance of re-canalisation following endovenous laser ablation (EVLA). Design: Prospective cohort study. Methods: Two groups were studied. Group A: 73 consecutive patients (84 GSVs) underwent EVLA followed by duplex ultrasound at 6, 12 and 52 weeks. Vein diameter and patency were recorded. Group B: From a prospectively maintained database 27 patients with a GSV that was found to have recanalised 6-12 weeks post-EVLA were identified and rescanned at 52 weeks. Pre- and post-treatment Aberdeen varicose vein severity scores (AVVSS) were measured. Results: Group A: 81/84 (96%) GSVs were ablated and 3/84 (4%) had re-canalised (flash reflux <1 s). GSV diameter diminished with time: pre-EVLA: mean diameter 7.7 S.D .2.0 mm; 6 weeks: 5.1 S.D. 1.3 mm; 12 weeks: 3.2 S.D. 1.2; 52 weeks: 85% non-visible (p < 0.001). Group B: 3/27 (11%) with reflux >1 s underwent repeat EVLA. 16/27 (59%) remained competent at 52 weeks and 8/27 (30%) showed trickle reflux. Vein diameter decreased in both subgroups (mean diameter 7.3 S.D. 2.5 mm to 3.1 S.D. 0.8 mm (p = 0.006) and 7.2 S.D. 2.3 mm to 3.0 S.D. 0.7 mm (p = 0.009) respectively) as did the AVVSS (p < 0.001). Conclusions: Successful EVLA causes GSV shrinkage with transition from a non-compressible "thrombosed" vein to a non-visible vein by 1 year. A re-canalised GSV usually remains small with no/minimal reflux and persisting clinical benefit. (C) 2008 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.