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Monday, June 8, 2015

Endovascular Laser Ablation (EVLA) for the Treatment of Chronic Venous Insufficiency

Endovascular laser ablation (EVLA) for the treatment of chronic venous insufficiency of the lower extremities can be applied to the perforating veins which connect the superficial and deep venous systems. This retrospective study evaluated outcomes of EVLA using a bare-tip fiber with a 1470 nm laser (with or without additional sclerotherapy or microphlebectomy) of 171 perforating veins in 87 patients with 3 month follow up. Of the 171 perforating veins, 49 had previous GSV disruption on the same extremity, 25 had previous SSV disruption on the same extremity, 88 had previous GSV and SSV disruption on the same extremity, and 9 had patent saphenous veins. On follow up, 94% of perforating veins were occluded at 1 month and 98% were occluded at 3 months. Complete chronic venous insufficiency symptom resolution was found to be 82% and 96% at 1 month and 3 month follow up, respectively. Perforator patency after ablation correlated with higher CEAP scores and the presence of prior GSV/SSV interruption.

This study demonstrates impressive success rates following bare tip EVLA of perforating veins, both in terms of perforating vein occlusion and improvement in clinical symptoms. The study results are likely more pertinent to patients with pre-existing saphenous interruption given the small subset of patients within the study without pre-existing saphenous interruption. While the clinical utility of treating perforating veins is uncertain and current recommendations from the American Venous Forum and the Society of Vascular Surgery argue for ablation only in close proximity to venous stasis ulcers or advanced disease, this study makes a case for revisiting these recommendations. Future studies with follow up extended past 3 months would be notable to determine long term efficacy of perforator ablation.

Click here to see the full abstract

Color US images demonstrate a dilated perforating vein in the region of the right medial calf with spontaneous bidirectional flow.

Citation: Chehab, M. et al. Endovenous Laser Ablation of Perforating Veins: Feasibility, Safety, and Occlusion Rate Using a 1,470-nm Laser and Bare-Tip Fiber. Journal of Vascular and Interventional Radiology 26, 871–877 (2015).

Post author: Brian Gardner, MD, Resident in the VIR Pathway, University of Virginia

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