Optimization of combined EVLA volume in treating patients with lower limb varicose disease

Introduction. In recent years, endovascular laser ablation (EVLO) technology has become the leading method for treating varicose veins. However, the effect of the volume of modern surgical interventions on the incidence of complications has not been studied.

Aim of the study. To assess the effect of EVLO volume on the incidence of complications

Materials and methods. The study was conducted on 967 patients from 2018 to 2021. All underwent combined operations in the volume of EVLO of saphenous veins in combination with an individual volume of miniphlebectomy. The age in the sample ranged from 29 to 80 years, the average age 51.5 years. A total of 381 EVLO of the main trunks of the saphenous veins were performed. Patients were divided into three groups depending on the volume of intervention. The treatment results were assessed on the 1st day, 7th day and during the first month after surgery.

Results. Unreasonable expansion of the minimally invasive treatment due to simultaneous combined interventions on both lower extremities significantly increases the trauma of endovascular thermal procedures, contributes to longer rehabilitation of patients and an increase in the number of adverse events in the early postoperative period. A significant increase in the number of complications with an increase in the scope of the operation was revealed.

Conclusion. Optimization of the scope of the operation can help reduce complications and improve rehabilitation.

1. Gohel M.S., Heatley F., Liu X., Bradbury A., Bulbulia R., Cullum N., Epstein D.M., Nyamekye I., Poskitt K.R., Renton S., Warwick J., Davies A.H. EVRA Trial Investigators. A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. N Engl J Med., 2018, May 31; № 378(22), рр. 2105–2114. https://doi.org/10.1056/NEJMoa1801214

2. Honěk T., Honěk J., Horváth V., Šlais M., Vítovec M., Stehno O., Šedivý P., Kneifl T., Fabián V., Šebesta P. Endovenous laser ablation of saphenous vein - mid-term results confirm permanent closure and possibility to treat more lesions in one procedure. Rozhl Chir., 2020, Summer; № 99(7), рр. 299–303. https://doi.org/10.33699/PIS.2020.99.7.299-303

3. Aurshina A., Alsheekh A., Kibrik P., Hingorani A., Marks N., Ascher E. Recanalization After Endovenous Thermal Ablation. Ann Vasc Surg., 2018, Oct; № 52, рр. 158–162. https://doi.org/10.1016/j.avsg.2018.03.017

4. Kochubey M.S., Siada S.S., Tenet M., Kiguchi M.M., Dirks R.C., O’Banion L.A. Thrombotic complications of superficial endovenous ablation: a contemporary review of thermal and non-thermal techniques. J Cardiovasc Surg (Torino), 2021, Oct; № 62(5), рр. 420–426. https://doi.org/10.23736/S0021-9509.21.11898-1

5. Duman E., Yildirim E., Saba T., Ozulku M., Gunday M., Coban G. The effect of laser wavelength on postoperative pain score in the endovenous ablation of saphenous vein insufficiency. Diagn Interv Radiol., 2013, Jul-Aug; № 19(4), рр. 326–329. https://doi.org/10.5152/dir.2013.023

6. Aurshina A., Ascher E., Victory J., Rybitskiy D., Zholanji A., Marks N., Hingorani A. Clinical correlation of success and acute thrombotic complications of lower extremity endovenous thermal ablation. J Vasc Surg Venous Lymphat Disord., 2018, Jan; № 6(1), рр. 25–30. https://doi.org/10.1016/j.jvsv.2017.07.001

7. Healy D.A., Kimura S., Power D., Elhaj A., Abdeldaim Y., Cross K.S., McGreal G.T., Burke P.E., Moloney T., Manning B.J., Kavanagh E.G. A Systematic Review and Meta-analysis of Thrombotic Events Following Endovenous Thermal Ablation of the Great Saphenous Vein. Eur J Vasc Endovasc Surg., 2018, Sep; № 56(3), рр. 410–424. https://doi.org/10.1016/j.ejvs.2018.05.008

8. Mazayshvili K., Akimov S. Early complications of endovenous laser ablation. Int Angiol., 2019, Apr; № 38(2), рр. 96–101. https://doi.org/10.23736/S0392-9590.19.04097-5

9. Nyamekye I.K. A practical approach to tumescent local anaesthesia in ambulatory endovenous thermal ablation. Phlebology, 2019, May; № 34(4), рр. 238–245. https://doi.org/10.1177/0268355518800191