Endovenous laser ablation for saphenous vein insufficiency: immediate and short-term results of our first 60 procedures.

C hronic venous insufficiency (CVI) affects approximately 20%– 40% of people in the western world (1). Its prevalence is higher among the elderly, females, and people living in developed countries (2). CVI occurs due to dysfunction of the venous valves. In normal individuals, these valves prevent blood, which is pumped to the lungs, from returning into leg veins. When these valves become incompetent due to some genetic or environmental causes, the blood refluxes into the leg veins and increases venous pressure. This venous hypertension results in gradual dilatation and tortuosity of the incompetent vein, as well as its subdermal venous branches, which are then called varicose veins (1, 2). CVI and varicose veins have a detrimental effect on patient quality of life; most patients have significant pain, cramping, burning sensations, and leg fatigue, which increase in the evening and after standing for long periods of time. In severe cases, leg edema, skin discoloration, and venous ulceration may develop. In rare cases, varicose veins may thrombose (superficial thrombophlebitis) and cause pulmonary embolism, or may bleed spontaneously, which could be dangerous if the leg is not promptly elevated (3, 4). Despite these problems, most patients did not undergo any treatment because until recently the only therapeutic options were surgery, which is invasive and has a high recurrence rate, and conservative measures, which are difficult for patients to comply with (2). This attitude, however, is expected to change with the widespread use of new treatment methods, such as endovenous laser (EVL) ablation and ultrasound (US) guided sclerotherapy. The modern management of CVI includes treatment of both the cause (reflux) and result (varicose veins). Naturally, reflux should be treated before varicosities because if the cause is not eliminated varicose veins will eventually recur (2). Elimination of reflux has been classically accomplished with surgery (2, 5); however, thermal ablation methods, such as EVL and radiofrequency ablation, are gradually becoming the treatment of choice (5). In this study, we present our single center experience with the first 60 EVL ablations, along with the immediate and short-term results.