ENDOVENOUS OBLITERATION OF LONG SAPHENOUS VEIN. A NEW MINIMAL INVASIVE METHOD OF TREATMENT FOR VARICOSE VEINS – PRELIMINARY REPORT

Background. Minimally invasive treatment of varicose veins is becoming more and more important as it represents less burden to the patient and health system. The success of the different methods depends on their capability to eliminate the reflux at the sapheno-femoral junction (SFJ) and the incompetent greater saphenous vein (GSV). In achieving these only three methods are successful: ultrasound (US) guided catheter sclerosation, radiofrequency or laser endovenous obliteration of GSV. Aims. To demonstrate a novel way to use a laser energy through an endoluminal laser fiber for the minimally invasive treatment of truncal varicosities and the elimination of SFJ reflux. Methods. The patients with US detected reflux in the SFJ and GSV were treated on the outpatient basis under local anaesthesia with laser mediated heat energy in the GSV 2–3 cm from SFJ with the laser of wave length of 980 nm with the power 15 W and the impulse duration of 1 sek. We used 20–40 impulses along the treated segment of GSV. The exact position of the laser fiber was determined by the US. The smaller branch varices were removed by mini phlebectomies. Patients tolerated well the procedure and they were dismissed from the hospital with applied compression stockings (CCL II) immediately after the completion of the procedure. The control US was done one week, four weeks and three months later. At one week one out of 16 patients presented with no occlusion of the GSV. At four weeks another patient had recanalisation of GSV but without the reflux. All other patients had the short GSV stump in which the patent epigastric vein was draining while the remaning part of the GSV was obliterated by the thrombus. Except for some skin ecchymosis and mild induration in the but patients did not have any other problems. The unsuccessful treatment in two patients is probably due to insufficient applied energy. Conclusions. Endovenous laser obliteration of GSV is an effective method that can be performed on the outpatient basis under local anaesthesia. Patients tolerate well the intervention. The preliminary results promise that the method, after additional experiences, could become in some patients an adequate alternative to classical surgical treatment of the varicosities of GSV, which remains the »the gold standard«.