Ways to improve EVLA: factors ensuring stable occlusion of the great saphenous vein's terminal segment

Introduction. Endovenous laser ablation is the most widely used method for treating lower extremity varicose veins. One primary cause of disease recurrence is pathological reflux persistence in the sapheno-femoral junction. Identifying factors affecting occlusion stability in the great saphenous vein's proximal segment may optimize surgical techniques and improve outcomes.

Aim. To identify clinical and tactical-technical factors influencing the effectiveness of endovenous laser ablation in achieving stable occlusion of the great saphenous vein's proximal segment in the sapheno-femoral junction.

Materials and methods. 'This prospective study involved 546 patients (692 limbs) with varicose veins treated by endovenous laser ablation. A novel method assessed occlusion effectiveness in the great saphenous vein's proximal segment. Twenty-one factors were analyzed, including 8 quantitative and 13 qualitative variables. Data were processed using descriptive statistics and gamma correlation analysis.

Results. High effectiveness (90,9 %) was achieved within 30 days post-procedure. Moderate correlations were observed with factors like manual traction technique for the laser fiber (y=0,495564), linear energy density >100 J/cm (y=0,459682), and specific energy density >40 J/cm² (y=0,41604). Mid-term results showed that in 35,6 % of cases, pathophysiological conditions promoting varicose vein progression persisted in the sapheno-femoral junction.

Conclusion. Endovenous laser ablation is highly effective for achieving stable occlusion of the great saphenous vein's sapheno-femoral junction. Several controllable factors significantly impact the procedure's success, offering opportunities for improved outcomes.

1. Savelyev V.S., Gologorsky V.A., Kirienko A.I. Phlebology: a guide for physicians. M: Meditsina, 2001, 664 p. (In Russ.)

2. Kamaev A.A., Bulatov V.L., Vakhratyan P.E. [et al.]. Varicose veins. Phlebology, 2022, № 1(16), pp. 41–108. (In Russ.)

3. Cowpland C.A., Cleese A.L., Whiteley M.S. Factors affecting optimal linear endovenous energy density for endovenous laser ablation in incompetent lower limb truncal veins – A review of the clinical evidence. Phlebology, 2017, № 5(32), рр. 299–306. https://doi.org/10.1177/0268355516648067

4. O’Donnell T.F., Balk E.M., Dermody M. [et al.]. Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2016, № 1(4), рр. 97–105. https://doi.org/10.1016/j.jvsv.2014.11.004

5. Hamann S.A.S., Giang J., DeMaeseneer M.G.R. et al. Editor’s choice – five-year results of great saphenous vein treatment: a meta-analysis. European journal of vascular and endovascular surgery, 2017, № 6(54), рр. 760–770. https://doi.org/10.1016/j.ejvs.2017.08.034

6. Huang Y., Zhang D., Zhou C., Zhang Y., Shi C., Chen Q. The first meta-analysis research on the effects of endovenous laser ablation combined with sapheno-femoral junction high ligation of the great saphenous vein. Lasers in medical science, 2023, № 38(1), рр. 175. https://doi.org/10.1007/s10103-023-03833-y.

7. Burleva E.P., Peshkov A.V., Tyurin S.A. [et al.]. Recurrences of varicose vein disease of the lower limbs: structure and tactical decisions (initial study). News of surgery, 2023, № (31), pp. 374–382. https://doi.org/10.18484/2305-0047.2023.5.374 (in Russ.)

8. Volkov A.S., Dibirov M.D., Shimanko A.I. [et al.]. Сomparison of the results of endovenous laser and radiofrequency ablation of the great saphenous vein trunk in the comprehensive treatment of patients with varicose vein disease of the lower limbs. Phlebology, 2020, № 14(2), pp. 91–98. (In Russ.)

9. Elzefzaf N., Elfeky M.A., Elshatlawy K.M. [et al.]. Evaluation of Endovenous Laser Ablation in the Management of Varicose Veins. Cureus, 2023, № 9(15), рр. e45096. https://doi.org/10.7759/cureus.45096

10. Guzhkov O.N. Assessment of the effectiveness of combined endovenous laser coagulation and echosclerotherapy in the comprehensive treatment of complicated forms of varicose vein disease. Angiology and vascular surgery, 2007, № 3(13), pp. 95–99. (In Russ.)

11. Potapov M.P., Aleksandrov Yu.K., Bogdanova Ya.I. Structural features of varicose vein recurrence in the lower limbs after endovenous laser ablation: a comparative analysis with classic phlebectomy. Infections in surgery, 2024, № 2(24), pp. 20–27. (In Russ.)