Role on tributaries GSV to formation long stump after endovenous laser treatment
M. Parikov, I. Kalitko, U. Dolidze, O. Smorodina Vascular Innovation Centre, St-Petersburg, Russia
Endovenous laser treatment (EVLT) is an effective treatment for thermal ablation of primary venous insufficiency involving the great saphenous vein (GSV). This study was designed to learn about value of the residual GSV stump following EVLT.
Methods. In this prospective study from January to September, 2008, 110 EVLT procedures were performed in 103 patients with a mean age of 47.7 years (range, 25-68 years). Average diameter of a proximal GSV 8,7 mm (range, 5-12 mm). A 1030-nm diode laser and microphlebectomy and foam-form sclerotherapy were used. The laser tip was positioned 5 mm distal to the saphenofemoral junction. Patients had clinical follow-up visits, including duplex ultrasound ex- amination, at 24 hours, 1 week, 1 month, 3 months, 6 month and were assessed for recanalization of the ablated vein, length of the GSV stump.
Results. A total of 106 great saphenous veins (96.36%) were ab- lated. Only in four cases (3,64%) the GSV recanalization was ob- served after 3 months. After 6 months the length stump GSV in 22,72% was <5 mm (n=25, group A), in 59,09% 5-8 mm (n=65, group B), in 21,82% >8 mm (n=24, group C). Group A: no reflux (100%), anterograde flow on tributaries (d<3 mm) in 60% (n=15). Group B: anterolateral tributary (100%), reflux 10,76% (n=7), anterograde flow 89,24% (n=58), d>3 mm in 23,08% (n=15). Group C: anterolateral tributary (100%), reflux 37,50% (n=9), d>3 mm in 50,00% (n=12), posteromedial tributary (54,17%, n=13), reflux 16,67% (n=4), d>3 mm in 33,33% (n=8).
Conclusion. In formation of length stump GSV plays a role an- terograde flow on tributaries GSV (anterolateral and posteromedial). Long stump (more than 8 mm) are formed at diameter of tributaries more than 3 mm. In such cases for the purpose of improvement of result of treatment probably it makes sense to carry out in addition EVLT tributaries GSV.