Endovenous laser ablation therapy in children: applications and outcomes

Abstract

BackgroundEndovenous laser ablation is well recognized as the first-line treatment for superficial venous reflux with varicose veins in adults. It is not widely reported and is not an established practice in pediatric patients.ObjectiveTo illustrate a variety of pediatric venous conditions in which endovenous laser ablation can be utilized and to demonstrate its feasibility and safety in children.Materials and methodsWe conducted a retrospective review of endovenous laser ablation procedures performed between January 2007 and July 2014 at two large pediatric institutions.ResultsWe included 35 patients (17 males) who underwent endovenous laser ablation to 43 veins. Median age at first treatment was 14 years (range: 3–18 years). Median weight was 56 kg (range: 19–97 kg). Underlying diagnoses were common venous malformation (15), Klippel–Trenaunay syndrome (8), superficial venous reflux with varicose veins (5), verrucous hemangioma-related phlebectasia (4), venous varix (2) and arteriovenous fistula (1). The most common aim of treatment was to facilitate sclerotherapy. Thirty-four patients had treatment in the lower limbs and one patient in an upper limb. Ten of the veins treated with endovenous laser ablation had an additional procedure performed to close the vein. Complications attributable to endovenous laser ablation occurred in two patients (6%). One patient experienced post-procedural pain and one patient developed a temporary sensory nerve injury. Median clinical follow-up was 13 months (range: 28 days–5.7 years). The aim of the treatment was achieved in 29 of the 35 (83%) patients.ConclusionEndovenous laser ablation is technically feasible and safe in children. It can be used in the management of a range of pediatric venous diseases with good outcomes.

Laser for vascular anomalies: successful outcomes in children

“…Furthermore, we must acknowledge that at GOSH we are lucky to have multidisciplinary experts treating vascular anomalies. Importantly, we have paediatricians using oral therapies such as propranolol and sirolimus, plastic surgeons resecting large lesions, and interventional radiologists performing endovascular ablations . This multidisciplinary approach to complex vascular anomalies allows for the best clinical outcomes for our patients.…”

Laser ablation of embryonic veins in children

“…Klippel–Trenaunay syndrome (KTS) and related overgrowth conditions are associated with persistent embryonic veins (PEV) . Pediatricians may be consulted to manage symptoms related to overgrowth or disfiguring vascular malformations.…”

“…Knowledge of the management of these embryonic veins is important. These ectatic anomalous veins have an increased risk of thromboembolism, and treatment of these veins has been advocated . Endovenous laser ablation therapy (EVLT) is a well‐recognized first‐line treatment for superficial venous reflux with varicose veins in adults .…”

“…Because of this thromboembolic risk, and also for symptomatic improvement, prophylactic closure of embryonic veins has been recommended, with the goal of shutting down these abnormal channels and diverting flow to the deep venous system. Surgical phlebectomy has been performed in the past, but more recently, EVLT has been used in KTS and other related overgrowth anomalies . It is a safe and effective treatment for dilated veins with rapid recovery, but its efficacy has been rigorously demonstrated only in adults with varicose veins .…”

“…It is a safe and effective treatment for dilated veins with rapid recovery, but its efficacy has been rigorously demonstrated only in adults with varicose veins . The published literature on the use of EVLT in children is limited …”