Topic: EVLA and sclerotherapy: Combined methods to treat superficial venous insufficiency and varices

Abstract

Background: Sclerotherapy for years has revolutionized phlebological treatments by making them less invasive. Its standardization and the operator experience now make it possible to treat chronic venous disease more closely following patients' requests: no anesthesia, no incisions and immediate recovery. However, combined techniques such as EVLA and sclerofoam, are performed for treatment of saphenous tributaries and recurrent varices.
Methods: Incompetent GSV and SSV segments in 3500 patients (2912 women, 588 men) with a mean age of 51.4 years were treated with EVLA using a 1470-nm diode laser (LASEmaR1500-Eufoton, Italy) with Frontal/Ring fibers. The GSV and SSV diameters were measured by Duplex examination. In all patients, sclerofoam was added for treating tributaries saphenous vein or recurrent varices. Patients were evaluated clinically and by duplex scanning at 8 days, 1 – 3 - 6 months, 1 – 2 - 3 years.
Results: A total of 3.661 GSV/SSVs with tributaries and recurrent varices were treated. EVLA was performed in GSV/SSV. LEED was proportional to the vein’s diameters. Sclerofoam was prepared utilizing Atoxisclerol (0.5% to 1.5%) proportional to vessel diameter. BARALDI'S PROCEDURE (performe vigorous skin massage along the course of the treated vein) was performed to all patients after sclerofoam injection; this allows to have better sclerofoam action/adhesion determining mechanical damage, added to chemical damage. The success of the procedure is suggested by the patient that immediately manifests local pain. The closure rate was 99.9% until 3-years follow-up. Major complications/failures never occurred.
Conclusion: EVLA of the incompetent GSV/SSV with a 1470-nm diode laser appears to be an extremely safe technique, particularly when the energy applied is calculated as a function of the GSV/SSV diameters. In addition, sclerotherapy (foam) represent a valid alternative to treat tributaries saphenous veins.