Combined Endovascular Laser Plus Ambulatory Phlebectomy for the Treatment of Superficial Venous Incompetence: a 4-Year Perspective
The article presents the study that aims to know the effectiveness of endovascular laser treatment and ambulatory phlebectomy with the aid of digital microscope in the treatment of superficial venous incompetence. Endovascular laser therapy is a technique that uses a laser with the aid of digital microscope to treat varicose veins. It indicated for patients with significant varicose veins who don’t wish to undergo traditional surgical intervention.Also known as EVLT, it is likewise indicated for large varicose veins and its main advantage is the short resting time after the procedure. Instead of removing the veins of great caliber as the saphenous vein, they are disabled in the procedure and treated by an optic micro fiber that transmits the LASER. The vein is not removed. It is disabled and separated from the circulation system. In the process of EVLT, the skin is numbed then a thin laser device that is connected to a digital microscope is introduced into the saphenous vein. The laser fiber is guided through the vein to the groin using an ultrasound machine .The vein is then perfused with a small amount of fluid by a needle and ultrasound. With the aid of digital microscope, laser is then turned on and pulled back through the vein, which ablates the vessel.
The great advantage is the postoperative that it is much more simple. The laser surgery is far less invasive than traditional surgeries such as vein stripping. Surgery is more effective than sclerotherapy because it is permanent. The surgery produces less bruises too. Patients can return shortly to the normal activities after the procedure. The equipment used in EVLT is a LASER of Diode. The laser emits a light bunch in the range of the infrared. This luminous energy is quite tamed, and used in the medicine in several fields. Ambulatory phlebectomy on the other hand is a method of surgical removal of surface varicose veins. This is usually done in the office using local anesthesia. Incisions are tiny and typically leave nearly imperceptible puncture mark scars. After the vein has been removed by phlebectomy, a bandage or a compression stocking is worn for a short period.
The study combines the endovascular laser obliteration of the greater saphenous vein in conjunction with ambulatory phlebectomy has become the treatment of choice for superficial venous incompetence. The study examines the treatment of saphenofemoral junction incompetence with simultaneous treatment of associated truncal varicosities by ambulatory phlebectomy. The patients in the study were observed for four years. They have been followed up for recurrence rate and complication. There were 90 patients involved in the study. They had a mean age 40 years. All had SFJ reflux associated with greater saphenous vein incompetence with a mean of 7.8 mm and enlargement of branch varicosities as documented by Duplex ultrasound.
Their problems were treated with a combined approach of endovascular laser obliteration of the GSV followed by hook avulsion or ambulatory phlebectomy of the remaining truncal varicosities. The follow up care was done by Duplex ultrasound to ensure closure was carried out at week 1 and months 1, 3, 6, 12, 24, 36 and 48. The results showed a total recurrence rate of 4.3 was found in the patient cohort. All recurrences occurred within 12 months, with the majority documented at month 6. The study concludes that the combination endovascular laser treatment with ambulatory phlebectomy is an effective treatment modality for superficial venous incompetence in the outpatient ambulatory setting. They also added that low recurrence rates are noted with this said treatment approach. In the present patient series, all recurrences were noted within 12 months of the aforementioned procedure. They further add that these results are comparable with other endovenous and radio frequency technologies. More on this topic
