Effectiveness of endovenous laser ablation treatment to incompetant perforator veins of lower extremities

Purpose: In this study, effectiveness of endovenous laser ablation (EVLA) treatment of perforating veins insufficiency at the lower extremities which are less common than superficial or deep vein insufficiencies, were investigated. Materials and Methods: Betweeen September 2009 -May 2013 a sum of 35 patients distributed as 12 male, 23 female, aged between 31-69 (mean:46,49±10,32), and weights between 52-99 (mean:74,89±12,3) were diagnosed with perforating vein insufficiency whose treated with EVLA were included in this study. Total 40 perforating veins at 40 extremities were ablated. Foam sclerotherapy with polydocanol at %1-3 concentration was injected to coexistent varicous veins simultaneously or after the EVLA procedure. Diagnosis was made by clinically and color doppler ultrasound examination. Patients were followed clinically and with Doppler Ultrasonography at first six month. To determine the severity of the venous disease Venous Clinical Severity Score (VCSS) and Clinical Status-Etiology-Anatomy-Pathophysiology (CEAP) classification system and visual analog scores (VAS) were administered before the procedures. Followups were planned annually. Results: 39 of 40 (%97,5) EVLA procedures had resulted with total occlusion of incompetent perforating veins by technical success and one procedure had resulted with partial occlusion of an incompetent perforator. Recanalisation was observed at 9 EVLA procedure (%22,5) in first 6 month followups. Primary success rate in 40 EVLA procedures was %77,5. Five of 9 EVLA procedures in which recanalization was observed, were treated again with EVLA. One of 5 were recanalized again and 4 of 5 not. Secondary treament success rate after repeated EVLA procedures was determined as %87,5 (35/40). Neither majör nor minör complication was not observed during or postprocedural follow-ups except some post procedural bruising and pain at the puncture site was seen on 2 patients (%5) which were disappeared shortly. CEAP, VCSS and Visual Analog Scores (VAS) evaluated at first six month. Change in CEAP, VCSS and visual analog scores in 6 month follow-ups were observed statistically significant (Wilcoxon Signed Ranks Test, p < 0,005). Conclusion: EVLA treatment in perforating veins of lower extremities is an effective, easy to perform, well tolerated, easy to repeat, and minimally invasive treatment with low rate of complications which can replace of SEPS and other similar surgical procedures, especially in patients who has not venous ulcers and has high cosmetic expectancies.