Endovenous Laser Ablation in Treating Perforating Veins: Technical Notes and 1-year Outcomes

Objective: Endovenous laser ablation (EVLA) represents the gold standard in treating both great and small saphenous veins (GSV and SSV) incompetence, despite few data have been reported on perforating veins (PVs). The aim of this study is to collect PVs treatment outcomes after EVLA, highlighting technical notes and decision making for the treatment.

Methods: From September 2012 to December 2022, all consecutive patients with PVs matching with inclusion criteria for endovenous ablation were selected and treated. A 1470-nm diode laser (LASEmaR® 1500, Eufoton, Trieste, Italy), with a kit that including 400–600-micron frontal optical fibres (Eufoton, Italy) was used. The optimal linear intravenous energy density (LEED) for the treatment was set according to PV diameter measured in an upright position in transversal section. The fiber tip was placed 1 cm from the deep venous PV margin. PVs’ characteristics as well as concomitant endovenous procedures were collected. Patients were evaluated clinically and by duplex scan 7 days, 6 months, and at 1 year after the procedure, assessing PV closure rate and adverse events.

Results: During the study period, a total of 147 PVs were treated in 143 patients (86 men, 57 women with a mean age of 51 years [range, 34 to 86 years] with CEAP classes of C2 (47), C3-C4 (69), C5-C6 (27). EVLA was used to treat Hach (26), Crocket I (29), Cocket II (31), Sherman (12), Dodd (49) perforating veins. The mean PV diameter was 6.5 mm (range, 4.0 to 6.5). The LEED was adjusted from 40 J/cm (4.0 mm) up to 60 J/Cm (6.5 mm). Concomitant procedures were GSV/SSV EVLA ablation (49), tributaries foam sclerotherapy (141), others (2 phlebectomies). At 7-day follow-up period, the closure rate was 100% and remained constant 1-year after the treatment. In 87 (60,8%) cases, complete disappearance of the perforators veins or residual fibrous cord was noted. No major complications were described; ecchymosis was seen in 17 (11.8%) patients.

Conclusions: The EVLA of PVs with a 1470-nm diode laser and a frontal fiber seems to be an extremely safe technique, particularly when the applied LEED is calculated as a function of the PV diameter. Careful decision making is essential in choosing to treat PVs, balancing venous haemodynamic changes and clinical outcomes.