Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Retrograde Endovenous Laser Ablation through Saphenopopliteal Junctional Area for Incompetent Small Saphenous Vein: Comparison with Antegrade Approach

  • Kim, Jun Seok (Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University School of Medicine) ;
  • Park, Sang Woo (Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine) ;
  • Yun, Ik Jin (Department of Surgery, Konkuk University Hospital, Konkuk University School of Medicine) ;
  • Hwang, Jae Joon (Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University School of Medicine) ;
  • Lee, Song Am (Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University School of Medicine) ;
  • Chee, Hyun Keun (Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University School of Medicine) ;
  • Hwang, Jin Ho (Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine)
  • Received : 2016.02.11
  • Accepted : 2016.03.02
  • Published : 2016.06.01
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Abstract

Objective: To evaluate the safety and efficacy of retrograde endovenous laser ablation (EVLA) and to compare it with the conventional antegrade EVLA for incompetent small saphenous vein (SSV). Materials and Methods: Small saphenous vein was cannulated via two approaches under ultrasound-guidance. One method involved puncturing the SSV cranially at mid-calf (the antegrade group). If the antegrade puncture into the SSV failed twice, the other approach for puncture was selected that involved puncturing the SSV toward the ankle (the retrograde group). Patients were evaluated in terms of technical & clinical success, closure rates of the SSV, and complications including pain, bruising, or paresthesia at all follow-up visits. Results: The 1470 nm endovenous laser was used in all limbs. Technical success was seen in all limbs in both groups (100%). Closure rate in both groups showed about 95%, without significant difference (p = 0.685). Similar linear endovenous energy density was supplied during the EVLA in both groups (p = 0.876). Three frequent complications including bruising, pain, and paresthesia did not show statistical significance between groups (p = 0.465, 0.823, 1.000, respectively). Major complications were absent in both groups. Conclusion: The EVLA for the incompetent SSV using a retrograde approach is safe and effective and should be considered the alternative method if the antegrade access fails due to vasospasm or small SSV diameter.

Keywords

Acknowledgement

Supported by : Konkuk University Medical Center

References

  1. Sam RC, Silverman SH, Bradbury AW. Nerve injuries and varicose vein surgery. Eur J Vasc Endovasc Surg 2004;27:113-120 https://doi.org/10.1016/j.ejvs.2003.11.007
  2. O'Hare JL, Vandenbroeck CP, Whitman B, Campbell B, Heather BP, Earnshaw JJ; Joint Vascular Research Group. A prospective evaluation of the outcome after small saphenous varicose vein surgery with one-year follow-up. J Vasc Surg 2008;48:669-673; discussion 674 https://doi.org/10.1016/j.jvs.2008.04.041
  3. Doganci S, Yildirim V, Demirkilic U. Does puncture site affect the rate of nerve injuries following endovenous laser ablation of the small saphenous veins? Eur J Vasc Endovasc Surg 2011;41:400-405 https://doi.org/10.1016/j.ejvs.2010.11.029
  4. Park SW, Yun IJ, Hwang JJ, Lee SA, Kim JS, Chee HK, et al. Fluoroscopy-guided endovenous sclerotherapy using a microcatheter prior to endovenous laser ablation: comparison between liquid and foam sclerotherapy for varicose tributaries. Korean J Radiol 2014;15:481-487 https://doi.org/10.3348/kjr.2014.15.4.481
  5. Desmyttere J, Grard C, Stalnikiewicz G, Wassmer B, Mordon S. Endovenous laser ablation (980 nm) of the small saphenous vein in a series of 147 limbs with a 3-year follow-up. Eur J Vasc Endovasc Surg 2010;39:99-103 https://doi.org/10.1016/j.ejvs.2009.09.011
  6. Samuel N, Wallace T, Carradice D, Shahin Y, Mazari FA, Chetter IC. Endovenous laser ablation in the treatment of small saphenous varicose veins: does site of access influence early outcomes? Vasc Endovascular Surg 2012;46:310-314 https://doi.org/10.1177/1538574412443316
  7. van Rij AM, Jiang P, Solomon C, Christie RA, Hill GB. Recurrence after varicose vein surgery: a prospective long-term clinical study with duplex ultrasound scanning and air plethysmography. J Vasc Surg 2003;38:935-943 https://doi.org/10.1016/S0741-5214(03)00601-3
  8. Theivacumar NS, Beale RJ, Mavor AI, Gough MJ. Initial experience in endovenous laser ablation (EVLA) of varicose veins due to small saphenous vein reflux. Eur J Vasc Endovasc Surg 2007;33:614-618 https://doi.org/10.1016/j.ejvs.2006.10.030
  9. Disselhoff BC, der Kinderen DJ, Moll FL. Is there recanalization of the great saphenous vein 2 years after endovenous laser treatment? J Endovasc Ther 2005;12:731-738 https://doi.org/10.1583/05-1627.1
  10. Park SW, Yun IJ, Hwang JJ, Lee SA, Kim JS, Chang SH, et al. Fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter in varicose tributaries followed by endovenous laser treatment of incompetent saphenous veins: technical feasibility and early results. Dermatol Surg 2009;35:804-812 https://doi.org/10.1111/j.1524-4725.2009.01136.x
  11. Almeida JI, Kaufman J, Gockeritz O, Chopra P, Evans MT, Hoheim DF, et al. Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol 2009;20:752-759 https://doi.org/10.1016/j.jvir.2009.03.008
  12. Perosi NA, Johnson MG, Berkmen T. Fluoroscopic-guided approaches to radiofrequency vein ablation. J Vasc Interv Radiol 2013;24:43-46 https://doi.org/10.1016/j.jvir.2012.09.025
  13. Leopardi D, Hoggan BL, Fitridge RA, Woodruff PW, Maddern GJ. Systematic review of treatments for varicose veins. Ann Vasc Surg 2009;23:264-276 https://doi.org/10.1016/j.avsg.2008.10.007
  14. Rashid HI, Ajeel A, Tyrrell MR. Persistent popliteal fossa reflux following saphenopopliteal disconnection. Br J Surg 2002;89:748-751 https://doi.org/10.1046/j.1365-2168.2002.02125.x
  15. Park SW, Hwang JJ, Yun IJ, Lee SA, Kim JS, Chang SH, et al. Endovenous laser ablation of the incompetent small saphenous vein with a 980-nm diode laser: our experience with 3 years follow-up. Eur J Vasc Endovasc Surg 2008;36:738-742 https://doi.org/10.1016/j.ejvs.2008.08.011
  16. Gibson KD, Ferris BL, Polissar N, Neradilek B, Pepper D. Endovenous laser treatment of the short saphenous vein: efficacy and complications. J Vasc Surg 2007;45:795-803 https://doi.org/10.1016/j.jvs.2006.11.059

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