Intravenous Catheter-Guided Laser Ablation: A Novel Alternative for Branch Varicose Veins

Abstract

It is difficult to manage tributary varicose veins with endovenous laser ablation. Using the intravenous catheter-guided laser fiber to ablate the tributary varicose veins has been proposed. From April 2004 to December 2009, we randomly assigned 134 patients with 170 limbs for laser therapy, of which, 89 limbs in 74 patients were treated with laser ablation. The residual tortuous veins were abolished with the intravenous catheter-guided laser ablation (ICLA group), whereas residual varicose veins in 81 limbs in 60 patients were treated by stab avulsion (SA group). Patients were followed up with the median of 44.5 months after surgery. The outcomes and durability of treatment in both groups were evaluated. The primary end point was recurrence of varicose veins. In comparison with the SA group, patients in the ICLA group had fewer surgical incisions and morbidity, a shorter hospital stay, and returned to normal activity earlier. The overall 5-year recurrence of varicose veins was infrequent in the ICLA group but was much higher in the SA group (5.4% versus 20%, P = 0.022). ICLA provided better outcomes than conventional SA in managing the branched varicose veins and may be an alternative for the treatment of branch varicose veins.

Retained Foreign Body After Laser Ablation

“…Many approaches have been used for the treatment of varicose veins [1][2][3][4] including ligation and stripping, foam sclerotherapy, radiofrequency, and laser therapy. Our previous studies 1,2 showed that laser therapy is better than trivex for tributary varicose veins, and laser therapy with catheter has its unique advantage in the treatment of tributary varicose veins.…”

“…It is characterized with earlier return to work, less pain, and improved quality of life after endovenous laser ablation in comparison with open surgery. [1][2][3][4][5] However, like many other surgical procedures, some related side effects, such as burns and blister, during or after laser ablation can occur. A retained foreign body could be left accidentally in the treated leg, which may cause postoperative discomfort or pain.…”

The Management of Varicose Veins

“…3 In this procedure, a catheter is inserted and positioned at 2 cm below the saphenofemoral or saphenopopliteal junction. Local anesthesia is used with perivenous tumescent technique to prevent neural damage and skin burn.…”

“…However, like other surgeries, EVLA still can cause operative or postoperative complications, such as hematoma, infection, skin burn, bruising, and catheter stabbing by laser fiber, or the broken catheter can be left in the body. 3,12,13 Many clinical studies and randomized controlled trials of high quality compared EVLA and conventional surgical procedures and showed no differences in postoperative pain, recurrence rates, or returning to work or normal activity. 7,14 Clinical experience shows that the pain after laser ablation contributes to the skin contusion caused between skin and uneven bandages used after the procedure, blisters induced by skin burn, and endovenous thermal-induced thrombosis and thrombophlebitis 7 ; all of these problems can be prevented with careful manipulation during the procedure.…”

“…1 Risk factors of varicose veins include family history, age, and pregnancy; a possible risk factor is standing for a long period of time. [1][2][3] High ligation and stripping is the traditional approach for varicose veins, yet a variety of alternative options have been used in recent decades, such as endovenous laser ablation (EVLA), endovenous radiofrequency ablation (RFA), foam sclerotherapy (FS), or TriVex. [4][5][6][7] Manifestation and Severity of Varicose Veins…”