Varicose Vein Treatment with Endovenous Laser Therapy

Varicose Vein Treatment with Endovenous Laser Therapy
February 15, 2007
Author: Craig Feied, MD, FACEP, FAAEM, FACPh
Coauthor(s): Robert Min, MD
eMedicine.com

Venous insufficiency from superficial reflux through varicose veins is a serious problem that usually is inexorably progressive if left untreated. When the refluxing circuit involves failure of the primary valves at the saphenofemoral junction, treatment options for the patient are limited, and early recurrences are the rule rather than the exception.

In a traditional surgical approach, ligation and division of the saphenous trunk and all proximal tributaries is followed by stripping or by avulsion phlebectomy. Proximal ligation requires a substantial incision at the groin crease. Stripping of the vein requires additional incisions at the knee or below the knee and is associated with a high incidence of minor surgical complications. Avulsion phlebectomy requires multiple 2- to 3-mm incisions along the course of the vein and can cause damage to adjacent nerves and lymphatic vessels.

Ablation of the vein by endovenous laser therapy (EVLT) is a newer procedure that is less invasive than surgery and has a lower complication rate. The procedure is well tolerated by patients and produces good cosmetic results. Excellent clinical results are observed at 2-4 years, but the long-term effectiveness of EVLT is not yet known. The varicose recurrence rate is less than 7% after 2 years, a rate comparable or superior to that reported for surgery, US-guided sclerotherapy, and radiofrequency ablation...