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Endovenous laser ablation for the treatment of lower extremity chronic venous disease

Author
Daniel M Ihnat, MD
Section Editors
Joseph L Mills, Sr, MD
John F Eidt, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Endovenous laser ablation (EVLA) is a percutaneous technique that uses laser energy to ablate incompetent superficial veins. The axial veins are the primary target for this therapy and include the great saphenous vein (GSV), small saphenous vein (SSV), and accessory saphenous veins (ASVs). This topic will review the indications, perioperative care and outcomes of EVLA.

Alternative approaches to the treatment of chronic venous disease using laser and light therapy, radiofrequency energy, liquid and foam sclerotherapy, and open surgical management are discussed elsewhere.

(See "Overview and management of lower extremity chronic venous disease".)

(See "Laser and light therapy of lower extremity telangiectasias, reticular veins and small varicose veins".)

(See "Radiofrequency ablation for the treatment of lower extremity chronic venous disease".)

                                                          

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Literature review current through: Nov 2016. | This topic last updated: Mon May 16 00:00:00 GMT+00:00 2016.
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References
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  1. Schoonover JP, King JT, Gray C, et al. 3 alternatives to standard varicose vein treatment. J Fam Pract 2009; 58:522.
  2. Kumari J, Nishanth Reddy N, Kalyani Rao P, et al. A review of literature along with a cadaveric study of the prevalence of the Giacomini vein (the thigh extension of the small saphenous vein) in the Indian population. Rom J Morphol Embryol 2008; 49:537.
  3. Gibson KD, Ferris BL, Polissar N, et al. Endovenous laser treatment of the small [corrected] saphenous vein: efficacy and complications. J Vasc Surg 2007; 45:795.
  4. Delis KT, Knaggs AL, Khodabakhsh P. Prevalence, anatomic patterns, valvular competence, and clinical significance of the Giacomini vein. J Vasc Surg 2004; 40:1174.
  5. Schweighofer G, Mühlberger D, Brenner E. The anatomy of the small saphenous vein: fascial and neural relations, saphenofemoral junction, and valves. J Vasc Surg 2010; 51:982.
  6. Caggiati A, Bergan JJ, Gloviczki P, et al. Nomenclature of the veins of the lower limbs: an international interdisciplinary consensus statement. J Vasc Surg 2002; 36:416.
  7. Dayan V, Cura L, Cubas S, Carriquiry G. Surgical anatomy of the saphenous nerve. Ann Thorac Surg 2008; 85:896.
  8. Schmedt CG, Sroka R, Steckmeier S, et al. Investigation on radiofrequency and laser (980 nm) effects after endoluminal treatment of saphenous vein insufficiency in an ex-vivo model. Eur J Vasc Endovasc Surg 2006; 32:318.
  9. Proebstle TM, Sandhofer M, Kargl A, et al. Thermal damage of the inner vein wall during endovenous laser treatment: key role of energy absorption by intravascular blood. Dermatol Surg 2002; 28:596.
  10. Mordon SR, Wassmer B, Zemmouri J. Mathematical modeling of endovenous laser treatment (ELT). Biomed Eng Online 2006; 5:26.
  11. Disselhoff BC, Rem AI, Verdaasdonk RM, et al. Endovenous laser ablation: an experimental study on the mechanism of action. Phlebology 2008; 23:69.
  12. Starodubtsev V, Lukyanenko M, Karpenko A, Ignatenko P. Endovenous laser ablation in patients with wide diameter of the proximal segment of the great saphenous vein: Comparison of methods. Phlebology 2015; 30:700.
  13. Kabnick LS. Outcome of different endovenous laser wavelengths for great saphenous vein ablation. J Vasc Surg 2006; 43:88.
  14. Chang CJ, Chua JJ. Endovenous laser photocoagulation (EVLP) for varicose veins. Lasers Surg Med 2002; 31:257.
  15. Doganci S, Demirkilic U. Comparison of 980 nm laser and bare-tip fibre with 1470 nm laser and radial fibre in the treatment of great saphenous vein varicosities: a prospective randomised clinical trial. Eur J Vasc Endovasc Surg 2010; 40:254.
  16. Malskat WS, Giang J, De Maeseneer MG, et al. Randomized clinical trial of 940- versus 1470-nm endovenous laser ablation for great saphenous vein incompetence. Br J Surg 2016; 103:192.
  17. Vuylsteke ME, Thomis S, Mahieu P, et al. Endovenous laser ablation of the great saphenous vein using a bare fibre versus a tulip fibre: a randomised clinical trial. Eur J Vasc Endovasc Surg 2012; 44:587.
  18. Hirokawa M, Kurihara N. Comparison of Bare-Tip and Radial Fiber in Endovenous Laser Ablation with 1470 nm Diode Laser. Ann Vasc Dis 2014; 7:239.
  19. Theivacumar NS, Gough MJ. Influence of warfarin on the success of endovenous laser ablation (EVLA) of the great saphenous vein (GSV). Eur J Vasc Endovasc Surg 2009; 38:506.
  20. Riesenman PJ, de Fritas DJ, Konigsberg SG, Kasirajan K. Noninterruption of warfarin therapy is safe and does not compromise outcome in patients undergoing endovenous laser therapy (EVLT). Vasc Endovascular Surg 2011; 45:524.
  21. Sharifi M, Mehdipour M, Bay C, et al. Effect of anticoagulation on endothermal ablation of the great saphenous vein. J Vasc Surg 2011; 53:147.
  22. Gabriel V, Jimenez JC, Alktaifi A, et al. Success of endovenous saphenous and perforator ablation in patients with symptomatic venous insufficiency receiving long-term warfarin therapy. Ann Vasc Surg 2012; 26:607.
  23. Armstrong MJ, Gronseth G, Anderson DC, et al. Summary of evidence-based guideline: periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013; 80:2065.
  24. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195.
  25. Monahan DL. Can phlebectomy be deferred in the treatment of varicose veins? J Vasc Surg 2005; 42:1145.
  26. Welch HJ. Endovenous ablation of the great saphenous vein may avert phlebectomy for branch varicose veins. J Vasc Surg 2006; 44:601.
  27. Hamel-Desnos C, Gérard JL, Desnos P. Endovenous laser procedure in a clinic room: feasibility and side effects study of 1,700 cases. Phlebology 2009; 24:125.
  28. Rudarakanchana N, Berland TL, Chasin C, et al. Arteriovenous fistula after endovenous ablation for varicose veins. J Vasc Surg 2012; 55:1492.
  29. Theivacumar NS, Dellagrammaticas D, Mavor AI, Gough MJ. Endovenous laser ablation: does standard above-knee great saphenous vein ablation provide optimum results in patients with both above- and below-knee reflux? A randomized controlled trial. J Vasc Surg 2008; 48:173.
  30. Theivacumar NS, Darwood RJ, Dellagrammaticas D, et al. The clinical significance of below-knee great saphenous vein reflux following endovenous laser ablation of above-knee great saphenous vein. Phlebology 2009; 24:17.
  31. Doganci S, Yildirim V, Demirkilic U. Does puncture site affect the rate of nerve injuries following endovenous laser ablation of the small saphenous veins? Eur J Vasc Endovasc Surg 2011; 41:400.
  32. de Medeiros CA, Luccas GC. Comparison of endovenous treatment with an 810 nm laser versus conventional stripping of the great saphenous vein in patients with primary varicose veins. Dermatol Surg 2005; 31:1685.
  33. Puggioni A, Kalra M, Carmo M, et al. Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: analysis of early efficacy and complications. J Vasc Surg 2005; 42:488.
  34. Desmyttère J, Grard C, Wassmer B, Mordon S. Endovenous 980-nm laser treatment of saphenous veins in a series of 500 patients. J Vasc Surg 2007; 46:1242.
  35. El-Sheikha J, Nandhra S, Carradice D, et al. Compression regimes after endovenous ablation for superficial venous insufficiency--A survey of members of the Vascular Society of Great Britain and Ireland. Phlebology 2016; 31:16.
  36. Gornik HL, Gerhard-Herman MD, Misra S, et al. ACCF/ACR/AIUM/ASE/IAC/SCAI/SCVS/SIR/SVM/SVS/SVU 2013 appropriate use criteria for peripheral vascular ultrasound and physiological testing part II: testing for venous disease and evaluation of hemodialysis access: a report of the american college of cardiology foundation appropriate use criteria task force. J Am Coll Cardiol 2013; 62:649.
  37. Lin JC, Peterson EL, Rivera ML, et al. Vein mapping prior to endovenous catheter ablation of the great saphenous vein predicts risk of endovenous heat-induced thrombosis. Vasc Endovascular Surg 2012; 46:378.
  38. Sadek M, Kabnick LS, Rockman CB, et al. Increasing the distance peripheral to the saphenofemoral junction may result in a diminished rate of endothermal heat-induced thrombosis. J Vasc Surg Venous Lymphat Disord 2014; 1:257.
  39. Rhee SJ, Cantelmo NL, Conrad MF, Stoughton J. Factors influencing the incidence of endovenous heat-induced thrombosis (EHIT). Vasc Endovascular Surg 2013; 47:207.
  40. Lawrence PF, Chandra A, Wu M, et al. Classification of proximal endovenous closure levels and treatment algorithm. J Vasc Surg 2010; 52:388.
  41. Kane K, Fisher T, Bennett M, et al. The incidence and outcome of endothermal heat-induced thrombosis after endovenous laser ablation. Ann Vasc Surg 2014; 28:1744.
  42. Carruthers TN, Farber A, Rybin D, et al. Interventions on the superficial venous system for chronic venous insufficiency by surgeons in the modern era: an analysis of ACS-NSQIP. Vasc Endovascular Surg 2014; 48:482.
  43. Kalteis M, Berger I, Messie-Werndl S, et al. High ligation combined with stripping and endovenous laser ablation of the great saphenous vein: early results of a randomized controlled study. J Vasc Surg 2008; 47:822.
  44. Christenson JT, Gueddi S, Gemayel G, Bounameaux H. Prospective randomized trial comparing endovenous laser ablation and surgery for treatment of primary great saphenous varicose veins with a 2-year follow-up. J Vasc Surg 2010; 52:1234.
  45. Dunst KM, Huemer GM, Wayand W, Shamiyeh A. Diffuse phlegmonous phlebitis after endovenous laser treatment of the greater saphenous vein. J Vasc Surg 2006; 43:1056.
  46. Marsh P, Price BA, Holdstock J, et al. Deep vein thrombosis (DVT) after venous thermoablation techniques: rates of endovenous heat-induced thrombosis (EHIT) and classical DVT after radiofrequency and endovenous laser ablation in a single centre. Eur J Vasc Endovasc Surg 2010; 40:521.
  47. Nwaejike N, Srodon PD, Kyriakides C. 5-years of endovenous laser ablation (EVLA) for the treatment of varicose veins--a prospective study. Int J Surg 2009; 7:347.
  48. Proebstle TM, Herdemann S. Early results and feasibility of incompetent perforator vein ablation by endovenous laser treatment. Dermatol Surg 2007; 33:162.
  49. Van Den Bos RR, Neumann M, De Roos KP, Nijsten T. Endovenous laser ablation-induced complications: review of the literature and new cases. Dermatol Surg 2009; 35:1206.
  50. Caggiati A, Franceschini M. Stroke following endovenous laser treatment of varicose veins. J Vasc Surg 2010; 51:218.
  51. Khilnani NM, Grassi CJ, Kundu S, et al. Multi-society consensus quality improvement guidelines for the treatment of lower-extremity superficial venous insufficiency with endovenous thermal ablation from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology and Canadian Interventional Radiology Association. J Vasc Interv Radiol 2010; 21:14.
  52. Timperman PE. Arteriovenous fistula after endovenous laser treatment of the short saphenous vein. J Vasc Interv Radiol 2004; 15:625.
  53. Vaz C, Matos A, Oliveira J, et al. Iatrogenic arteriovenous fistula following endovenous laser therapy of the short saphenous vein. Ann Vasc Surg 2009; 23:412.e15.
  54. van den Bos R, Arends L, Kockaert M, et al. Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg 2009; 49:230.
  55. Darwood RJ, Theivacumar N, Dellagrammaticas D, et al. Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins. Br J Surg 2008; 95:294.
  56. Rasmussen LH, Bjoern L, Lawaetz M, et al. Randomised clinical trial comparing endovenous laser ablation with stripping of the great saphenous vein: clinical outcome and recurrence after 2 years. Eur J Vasc Endovasc Surg 2010; 39:630.
  57. Ravi R, Rodriguez-Lopez JA, Trayler EA, et al. Endovenous ablation of incompetent saphenous veins: a large single-center experience. J Endovasc Ther 2006; 13:244.
  58. Agus GB, Mancini S, Magi G, IEWG. The first 1000 cases of Italian Endovenous-laser Working Group (IEWG). Rationale, and long-term outcomes for the 1999-2003 period. Int Angiol 2006; 25:209.
  59. Kim HS, Paxton BE. Endovenous laser ablation of the great saphenous vein with a 980-nm diode laser in continuous mode: early treatment failures and successful repeat treatments. J Vasc Interv Radiol 2006; 17:1449.
  60. Chaar CI, Hirsch SA, Cwenar MT, et al. Expanding the role of endovenous laser therapy: results in large diameter saphenous, small saphenous, and anterior accessory veins. Ann Vasc Surg 2011; 25:656.
  61. Florescu C, Curry G, Buckenham T. Role of endovenous laser therapy in large and very large diameter great saphenous veins. ANZ J Surg 2016; 86:608.
  62. Atasoy MM. Efficacy and Safety of Endovenous Laser Ablation in Very Large and Tortuous Great Saphenous Veins. J Vasc Interv Radiol 2015; 26:1347.
  63. Bush RG, Hammond K. Treatment of incompetent vein of Giacomini (thigh extension branch). Ann Vasc Surg 2007; 21:245.
  64. Theivacumar NS, Dellagrammaticas D, Mavor AI, Gough MJ. Endovenous laser ablation (EVLA) of great saphenous vein to abolish "paradoxical reflux" in the Giacomini vein: a short report. Eur J Vasc Endovasc Surg 2007; 34:229.
  65. Ravi R, Trayler EA, Barrett DA, Diethrich EB. Endovenous thermal ablation of superficial venous insufficiency of the lower extremity: single-center experience with 3000 limbs treated in a 7-year period. J Endovasc Ther 2009; 16:500.
  66. Nwaejike N, Srodon PD, Kyriakides C. Endovenous laser ablation for short saphenous vein incompetence. Ann Vasc Surg 2009; 23:39.
  67. Trip-Hoving M, Verheul JC, van Sterkenburg SM, et al. Endovenous laser therapy of the small saphenous vein: patient satisfaction and short-term results. Photomed Laser Surg 2009; 27:655.
  68. Theivacumar NS, Darwood RJ, Gough MJ. Endovenous laser ablation (EVLA) of the anterior accessory great saphenous vein (AAGSV): abolition of sapheno-femoral reflux with preservation of the great saphenous vein. Eur J Vasc Endovasc Surg 2009; 37:477.
  69. Kontothanassis D, Di Mitri R, Ferrari Ruffino S, et al. Endovenous laser treatment of the small saphenous vein. J Vasc Surg 2009; 49:973.
  70. Monahan TS, Belek K, Sarkar R. Results of radiofrequency ablation of the small saphenous vein in the supine position. Vasc Endovascular Surg 2012; 46:40.
  71. She W, Dai Y, Du X, et al. Hearing evaluation of intratympanic methylprednisolone perfusion for refractory sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 2010; 142:266.
  72. Ozkan U. Endovenous laser ablation of incompetent perforator veins: a new technique in treatment of chronic venous disease. Cardiovasc Intervent Radiol 2009; 32:1067.
  73. Park SW, Hwang JJ, Yun IJ, et al. Randomized clinical trial comparing two methods for endovenous laser ablation of incompetent perforator veins in thigh and great saphenous vein without evidence of saphenofemoral reflux. Dermatol Surg 2012; 38:640.
  74. Hoggan BL, Cameron AL, Maddern GJ. Systematic review of endovenous laser therapy versus surgery for the treatment of saphenous varicose veins. Ann Vasc Surg 2009; 23:277.
  75. Darwood RJ, Gough MJ. Endovenous laser treatment for uncomplicated varicose veins. Phlebology 2009; 24 Suppl 1:50.
  76. Rasmussen LH, Bjoern L, Lawaetz M, et al. Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: short-term results. J Vasc Surg 2007; 46:308.
  77. Rasmussen L, Lawaetz M, Bjoern L, et al. Randomized clinical trial comparing endovenous laser ablation and stripping of the great saphenous vein with clinical and duplex outcome after 5 years. J Vasc Surg 2013; 58:421.
  78. Shepherd AC, Gohel MS, Brown LC, et al. Randomized clinical trial of VNUS ClosureFAST radiofrequency ablation versus laser for varicose veins. Br J Surg 2010; 97:810.
  79. Flessenkämper I, Hartmann M, Hartmann K, et al. Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatment of great saphenous varicose veins: Results of a multicentre randomised controlled trial with up to 6 years follow-up. Phlebology 2016; 31:23.
  80. Brittenden J, Cotton SC, Elders A, et al. A randomized trial comparing treatments for varicose veins. N Engl J Med 2014; 371:1218.
  81. Pronk P, Gauw SA, Mooij MC, et al. Randomised controlled trial comparing sapheno-femoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anaesthesia: one year results. Eur J Vasc Endovasc Surg 2010; 40:649.
  82. Carradice D, Mekako AI, Mazari FA, et al. Randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. Br J Surg 2011; 98:501.
  83. Samuel N, Carradice D, Wallace T, et al. Randomized clinical trial of endovenous laser ablation versus conventional surgery for small saphenous varicose veins. Ann Surg 2013; 257:419.
  84. Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc Interv Radiol 2003; 14:991.
  85. Carradice D, Mekako AI, Mazari FA, et al. Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. Br J Surg 2011; 98:1117.
  86. Rass K, Frings N, Glowacki P, et al. Comparable effectiveness of endovenous laser ablation and high ligation with stripping of the great saphenous vein: two-year results of a randomized clinical trial (RELACS study). Arch Dermatol 2012; 148:49.
  87. Tassie E, Scotland G, Brittenden J, et al. Cost-effectiveness of ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery as treatment for primary varicose veins from the randomized CLASS trial. Br J Surg 2014; 101:1532.
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