Endovenous laser ablation for the treatment of recurrent varicose vein disease - A single centre experience

Introduction: Varicose vein surgery for recurrent disease can result from inadequate primary surgery. Redo open surgery is more difficult to perform than primary surgery and can be associated with a higher incidence of neurovascular injury and infection. In this study we evaluate EVLA, a percutaneous technique that uses intra-operative duplex ultrasound as an option for the treatment of recurrent varicose veins. Materials and Methods: Data prospectively collected on patients who had EVLA for varicose veins were obtained from our dedicated vascular registry. From November 2004 to December 2008 we performed 586 EVLA procedures, 77 procedures were for recurrent varicose veins. Results: The mean age was 52 +/- 12.77 years, range 28-80; and 48 (62%) were female. 64 (83%) cases were for recurrent LSV disease, 13 (17%) cases for recurrent SSV disease and all patients had LSV or SSV incompetence confirmed on preoperative duplex assessment. Median duration since primary surgery was 60 months (range 2-360). Mean length of vein treated was LSV - 36 cm +/- 14.5 (6-73) and SSV - 14.5 cm +/- 7.35 (5-24); mean energy delivered was LSV 3102J +/- 1053 (150-4656) and SSV -693J +/- 396 (135-1216). 17 patients had bilateral EVLA for recurrent disease at the same setting with one patient having bilateral procedures under local anaesthetic. There was an incidence of pulmonary embolism 10 days post EVLA and two patients required further phlebectomies post EVLA for residual varices that were present pre-operatively. Median follow-up was 18 months (range 1-38), with no clinical recurrence and no recannalisation of the treated LSV or SSV on duplex ultrasound. Conclusions: In our experience EVLA can be safely performed for recurrent varicose vein disease. In our experience Redo EVLA is not more difficult than primary EVLA to perform. (C) 2010 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.