Combined endovascular laser plus ambulatory phlebectomy for the treatment of superficial venous incompetence: a 4-year perspective.

BACKGROUND: Combination endovascular laser obliteration of the greater saphenous vein in conjunction with ambulatory phlebectomy has become the treatment of choice for superficial venous incompetence.

OBJECTIVES: The present study examines the treatment of saphenofemoral junction (SFJ) incompetence with simultaneous treatment of associated truncal varicosities by ambulatory phlebectomy.

METHODS: Four-year follow-up data for recurrence rate and complication profile was ascertained for 90 patients (mean age 40 years) with SFJ reflux associated with greater saphenous vein (GSV) incompetence (4-12 mm; mean 7.8 mm) and enlargement of branch varicosities as documented by Duplex ultrasound, which were treated with a combined approach of endovascular laser obliteration of the GSV (810 nm, Diomed S30) followed by hook avulsion (ambulatory phlebectomy) of the remaining truncal varicosities. Follow-up by Duplex ultrasound to ensure closure was carried out at week 1 and months 1, 3, 6, 12, 24, 36 and 48.

RESULTS: A total recurrence rate (r = 94 limbs) of 4.3 was found in the patient cohort. All recurrences occurred within 12 months, with the majority documented at month 6.

CONCLUSIONS: Combination endovascular laser treatment (EVLT) with ambulatory phlebectomy is an effective treatment modality for superficial venous incompetence in the outpatient ambulatory setting. Low recurrence rates are noted with this approach. In the present patient series, all recurrences were noted within 12 months of the aforementioned procedure. These results are comparable with other endovenous and radiofrequency technologies.