Aim. To evaluate the results of treatment of patients with varicose disease of the lower extremities using endovenous laser obliteration. Methods. Endovenous laser obliteration of the saphenous and perforating veins was used in the treatment of 72 patients with varicose disease of the lower extremities by applying a laser with a wavelength of 1.56 µm. The intervention technique included puncturing and catheterizing of the great saphenous vein or small saphenous vein under ultrasound angioscanning control followed by an introduction of the laser fiber-optic light guide and advancing it to the level of the saphenofemoral or saphenopopliteal junction. After paravasal introduction of the anesthetic solution the laser obliteration was performed under ultrasound control. Results. Postoperatively noted was the low intensity of pain, low severity of ecchymosis and no tenderness along the obliterated veins. No complications were recorded. 40 patients were examined in follow-up during the period from 2 to 4 months after the endovenous laser obliteration. The degree of obliteration of 39 great saphenous veins, 2 small saphenous veins and 8 perforating veins was evaluated. In all cases complete obliteration of veins subjected to laser exposure was noted, no abnormal refluxes or areas of preserved blood flow were revealed. Conclusion. The endovenous laser obliteration is a mini-invasive effective method of providing a complete occlusion of the blood vessel, which eliminates the vertical and horizontal pathological reflux in varicose disease of the lower extremities; this technique can be used in an outpatient setting.

Results: Among forty-five patients, 33 had loss while 12 had intact SMAD4. Loss of SMAD4 carries a 1.3 times increased risk of vascular and 1.6 times risk of nodal spread. Deletion of SMAD4 was associated with poor differentiation (p=0.04,OR=5.6,C.I=0.9-34.4), and increased the risk of perineural invasion by two times (OR=2,C.I=0.1-34.8). Thirty-three, eighteen, and five patients survived at the end of 6, 12 and 24 months respectively. Analysis revealed statistically significant association between SMAD4 loss and survival at six months (p=0.04), 12 months (p=0.01) and 24 months (p=0.007). Among the operated patients (n=19), eleven patients developed recurrence during follow-up, period. all had loss of SMAD4 (p=0.03). The hazard ratios for poor tumor differentiation and SMAD4 loss were 5.8 (95%C.I=1.2-28.4,p=0.02) and 6.7 (HR=6.7,95%C.I=1.9-23.3,p=0.002) respectively. The SMAD4 intact and loss group had median survival of 19.5+2.1 months (95%C.I=15.4-23.7) and 9.3+1.0 months (95%C.I=7.3-11.4) respectively, confers a survival advantage of 10 months (p=0.002,C.I.=-4.1to-0.9). Conclusion: Loss of SMAD4 is strongly associated with poor tumor differentiation with risk of metastasis at presentation. The overall survival is significantly influenced by the loss of SMAD4 and poor tumor differentiation.