Endovenous laser treatment (EVLT) in saphenous vein insufficiency. Preliminary study

BACKGROUND: The aim of this study was to verify the efficacy of this novel method for the treatment of chronic venous insufficiency. METHODS: From 1/09/2002 to 30/09/2004 we treated 150 patients with internal saphenous vein insufficiency using the EVLT® treatment. The laser device used was adiode laser with an energy emission of 810 nm. We performed the procedure in all cases in the operating theater. In the cases of percutaneous insertion, we used the ecodoppler intraoperative evaluation. The ecodoppler control was performed in all cases to test the endoluminal and sapheno-femoral cross right position. This was also confirmed by skin transillumination. General anaesthesia was used only in the first 7 (4.6 %) patients; peridural anaesthesia was performed in 38 (25.4 %) patients and loco-regional anaesthesia in 105 (70 %). Where necessary, we performed flebectomies using the Muller technique. RESULTS: In the first two (6 %) cases we observed an incomplete but asymptomatic saphenous vein obliteration due to an incorrect technique. In 138 (92 %) cases, there was a completed saphenous vein obliteration at the one-month ecocolordoppler control and the ecocolordoppler vein identification was very difficult at the 4-month followup. The initial 21 (14 %) patients were submitted to a sixmonth ecocolordoppler control with complete obliteration of the treated vein in all cases. At the 12-month follow-up, of the 90 patients examined, 87 were found to have a complete vein obliteration and 90 were symptom-free, and at the 24-month follow-up, 37 of the 40 patients examined had a complete vein obliteration. CONCLUSIONS: Modern surgery aims at being as minimally invasive as possible. Laser treatment in our opinion, and in this we are supported by the literature, may be the best alternative to traditional surgery for chronic venous insufficiency due to its avoidance of skin incision, and incision-associated complications, with optimal early and late surgical results.