Objective: The relative safety of surgical and interventional treatments for saphenous vein aneurysms is unclear. The treatment method choice depends on the patient's preferences and the surgeon's experience. EVLT appears less likely to be complicated by bleeding or deep vein damage. It is technically challenging to compress the vein lumen using tumescent anaesthesia fully and to boil the "blind pockets" that form when the vein collapses during EVLT.
Methods: A 63-year-old man complained of a protrusion preventing him from walking. Previously, many times suffered thrombophlebitis of varicose veins on the lower leg and thigh. After the initial diagnosis of an inguinal hernia was rejected, he was offered an open phlebectomy for a varicose GSV. The patient categorically refused open surgery. According to the results of DUS, a non-thrombotic aneurysm of the GSV with a diameter of up to 6 cm and a length of 8 cm was revealed, beginning immediately below the saphenofemoral anastomosis with a diameter of 3 cm, СЕАР: C2,3,4b, S, Ep, As, Pr GSVa, NSV, LII. The patient agreed to EVLK. The procedure was carried out on 2023.06.26 using two light guides inside the aneurysm parallel to one another. Local tumescent anaesthesia was pumped through 4 pre-placed catheters on the left, right, above and below the aneurysm.
Results: After the procedure, taking into account the thrombotic history and the left varicose tributaries on the legs, oral anticoagulants were prescribed. The patient went to work the next day. The follow-up 2 days, 2 weeks and 2 months after EVLT showed good health, a marked decrease in protrusion and ease of walking. Ultrasound control after 2 months showed obliteration of the GSV on the thigh.
Conclusions: Difficulties in EVLT of saphenous vein aneurysms are surmountable and are not dangerous for the life and health of the patient. Unlike open surgery, the patient can return to daily activities the very next day. EVLT does not create obstacles to the appointment (or continuation) of adequate anticoagulant therapy.
