Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 4  |  Page : 321-331

Endovenous laser therapy in varicose veins-recanalization rate and quality of life


Department of Vascular Surgery, Ruby Hall Clinic, Pune, Maharashtra, India

Date of Submission11-Dec-2020
Date of Acceptance19-Apr-2021
Date of Web Publication9-Dec-2021

Correspondence Address:
Kritika Tiwari
Department of Vascular Surgery, Ruby Hall Clinic, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_169_20

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  Abstract 


Context: In endovenous ablation under ultrasound guidance the saphenous vein is percutaneously accessed and the catheter is advanced cephalad toward the saphenofemoral junction. Tumescent anesthesia and thermal energy are used in concert to provide an effective means of eliminating great saphenous vein reflux. Aims and Objectives: Primary objective – (1) To study recanalization rate after light amplification stimulated by emission of radiation (LASER) in the varicose vein. Secondary Objectives are to Study – (1) Clinical effectiveness of LASER in varicose veins. (2) Quality of life (QoL). Materials and Methods: Single institute based prospective observational study of 81 patients undergoing LASER ablation for varicose veins was observed for 12 months post LASER ablation. Patients were assessed for residual varicosities, new varicosities, recurrence, complications, and QoL. Results: There was no recanalization of ablated veins at the end of 12 months. About 96.3% of patients remained free from developing new varicosities, whereas only 18.5% of patients had residual varicosities postprocedure at the initial follow-up which has been successfully treated with foam sclerotherapy. QoL postprocedure improved significantly with 69 patients (85.2%) had excellent QoL after 12 months postprocedure. Conclusion: (1) Least residual varicosities postprocedure treated by foam sclerotherapy. (2) Development of new varicosities occurs late in follow-up. (3) Zero recurrence rate of ablated veins through LASER. (4) Postopearative complication of pain and paraesthesia are minimal due to adequate tumescent anesthesia. (5) Dreaded complication of deep venous thrombosis is not recorded in any of the cases because of early ambulation. (6) There is a significant improvement in QoL of patients from the start to the end of the study.

Keywords: Light amplification stimulated by emission of radiation, light amplification stimulated by emission of radiation ablation, quality of life, recanalization rate, varicose veins


How to cite this article:
Tiwari K, Kamerkar DR, Shinde B. Endovenous laser therapy in varicose veins-recanalization rate and quality of life. Indian J Vasc Endovasc Surg 2021;8:321-31

How to cite this URL:
Tiwari K, Kamerkar DR, Shinde B. Endovenous laser therapy in varicose veins-recanalization rate and quality of life. Indian J Vasc Endovasc Surg [serial online] 2021 [cited 2022 Jan 23];8:321-31. Available from: https://www.indjvascsurg.org/text.asp?2021/8/4/321/332044




  Introduction Top


Millions of people seek medical attention for varicose veins because of their cosmetic appearance or associated symptoms. Although often minimized, the cosmetic consequences may adversely affect an individual's quality of life (QoL) and greater socioeconomic impact is seen with more advanced venous disease.

The evolution of minimally invasive techniques for the treatment of great saphenous vein (GSV) reflux has culminated in the development of Endovenous ablation (EVA).

EVA uses a bare-tipped or jacket-tipped fibre to deliver laser energy to a target area and form thermal energy within the vein lumen.[1],[2] The thermal energy generates heat and steam bubbles within the lumen of the target vessel, destroying the endothelial lining of the vessel. This causes an inflammatory reaction resulting in a thrombotic occlusion that effectively closes off the vein and eventually leads to fibrosis.[1],[3]


  Materials and Methods Top


Study site

Ruby hall clinic, Pune, a tertiary care hospital.

Study population

All in-patients posted for Endovenous laser ablation of varicose vein in Ruby hall clinic hospital from August 2017 to 2019.

Study design

Single institution-based prospective observational study.

Sample size

81.

Sample size justification and calculation

The reference literature has shown a prevalence between 10% and 30% and Precision d = 0.10 A sample size 81 is require for this study, to achieve a power of 80% and a level of significance of 5% (two-sided), for detecting a true difference in means between the test and the reference group of 0.10.[4]



Where,

P = 0.30 # Prevalence#

E = difference (precision) =0.10

α = 5% # Level of significance#

1− β = 0.80 # Power = 1 − β#

Sample size is determined by using R software

P = 0.30

>Q = 1 − P

>Q

[1] 0.7

>d = 0.10

>Z = 1.96 # Standard normal table value at 5% level of significance#

>n = (Z/d)2× (P × Q)

>n # Required sample size #

80.6736.

Study duration

Patients who have undergone EVA for varicose veins from August 2017 to 2019.

Data collection was done till 81 sample size was achieved. Simultaneous follow-up was kept for every sample till 12 months.

Inclusion criteria

All patients who underwent laser for varicose veins in Ruby hall clinic, Pune and consented for follow were included in study satisfying the following criteria:

  1. Unilateral varicose veins
  2. Bilateral varicose veins
  3. Patients who underwent endovascular laser
  4. Varicose veins involving GSV, short saphenous vein, anterior thigh veins
  5. Varicose veins with sapheno-femoral junction insufficiency
  6. Varicose veins with perforators insufficiency with truncal veins insufficiency
  7. Varicose veins with sapheno-popliteal junction insufficiency.


Exclusion criteria

  1. Varicose veins with acute infection
  2. Varicose vein with deep-vein thrombosis
  3. Varicose veins in children
  4. Patients who are not willing for follow-up
  5. Patients who are unfit for surgery
  6. Excessive tortuous varicose veins.


Methodology

All patients who underwent laser with attributes of inclusion criteria admitted in ruby hall clinic, Pune were included. The study was done in the period from August 2017 to 2019. All of them were follow upto 12 months.

Informed consent was obtained from each patient recruited for this study after explaining the nature and procedure of treatment being given in the study.

Initial data collected included:

  • Complete history of the patient regarding age, gender, side of varicose veins, presence of venous ulcer, and associated comorbidities.
  • Complete physical examination including general examination, detailed examination of superficial vein involved, preoperative QoL and ulcer if present.
  • All patients with varicose veins were investigated with the routine preoperative investigation and colour doppler.
  • Procedure for the patient is planned according to truncal and perforator vein involved.


All information along with identity of participants is kept confidential. Clinical parameter to be studied [Table 1].
Table 1: Patient's information

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Sequence of procedure

  • On admission, complete assessment of the patient was done including local and general examination with routine blood investigation.


    1. On the day of EVA, ultrasonography (USG)-guided marking of incompetent vein and perforators are done by assigned radiologist.
    2. Marked veins are applied with surface anaesthesia ointment (priloxicaine + lidocaine).
    3. Patient is taken inside operation theatre complex walking. On table reverse trendlenberg position given
    4. Before starting procedure single-shot antibiotic given by standby anaesthetist.
    5. After painting and draping, mid-leg/above ankle level puncture taken for long saphenous vein (LSV) and for small saphenous vein (SSV) mid-leg level puncture taken with 18G needle under local anaesthesia and in USG guidance.
    6. After confirmation of free flow of blood, guide wire (0.038) inserted through the needle by modified seldinger technique then, sheath (5 F) 11 cm laser fibre inserted under USG guidance, fibre tip confirmed 2.5 cm proximal to Sapheno-femoral junction (SFJ) under USG guidance.
    7. Trendelenburg position (head low) position is confirmed before starting tumescent anaesthesia.
    8. Thousand four seventy mille meter is the wavelength of fibre used for all laser ablations.
    9. USG-guided tumescent anaesthesia (we used 30 ml of plain xylocaine added to 465 ml NS with 5 ml soda bicarbonate to neutralise solution) is given using 24G needle by radiologist with the help of tumescent pump along the truncal superficial vein.
    10. Vein is ablated by the sequential withdrawal of laser fibre by 1 cm after reconfirming the tip of laser fibre 2.5 cm proximal to SFJ.
    11. In the presence of perforator incompetence with dilatation more than 3 mm perforators are ligated with separate cut down incisions.


    12. Perforator ligation at unhealthy area of skin is avoided.

    13. After completion of the procedure, deep venous thrombosis (DVT) prophylactic dose of ENOXAPARIN given and class 2 compression stockings applied in elevated leg and patient is shifted to recovery room by walking.
    14. Patient adviced to ambulate immediately.
    15. Patient can be discharged same day in the evening.


  • Patients with small calibre vein required cut down incision for insertion of laser fibres
  • Patients with low threshold of pain and anxiety have given anxiolytic dose of sedation by stand by anaesthetist which will not hinder immediate ambulation of the patient postprocedure
  • New light amplification stimulated by emission of radiation (LASER) fibre is used for every case
  • Those who required full-dose sedation not ambulated immediately
  • After 4–6 h ambulation in ward is confirmed.


On discharge, the patient was advised to continue stocking for 1 month with the first 7 days for 24 h. Patient discharged with prophylactic dose of oral anticoagulation for 5 days and micronized purified flavonoids fractions for 1 month.

Follow-up

Patients were followed up after laser ablation for 1 year at intervals of:

  1. 15 days
  2. 1 month
  3. 6 months
  4. 12 months.


    • At follow up residual varicosities are examined. These are assessed till the maximum of 6 months. If residual varicosities are not subsided, Foam sclerotherapy is given to resolve residual varicosities
    • Lower limbs were examined for the development of new varicosities at all follow-ups
    • Recurrence or recanalization of ablated veins was confirmed on doppler scans done at 6 month and 1-year follow-ups
    • Assessment of QoL at follow-ups was done by scoring the questionnaire prepared. The minimum score given is 48 and the maximum score given is 190. Accordingly, scores are divided into four categories as following:


      1. 48–83 = Poor
      2. 84–119 = Fair
      3. 120–155 = Good
      4. 156–190 = Excellent


    Maximum to minimum score are given from the option showing excellent QoL to poor QoL respectively.

    • Postoperatively signs of development of DVT is studied as it can be one of the major and important complication of laser ablation.
    • Postoperative complications were studied with most common being pain and paraesthesia
    • Patient underwent duplex scan at 6 month and 1 year follow-up to find out any budding varicosities.


Parameters studied on follow up:

  1. New varicosities developed
  2. Recurrence of treated varicosities
  3. Assessment of QoL by questionnaire prepared
  4. Signs of development of deep vein thrombosis
  5. Duplex scan findings at 6 months and 1 year follow-up.


End point

End point of study was achieved when:

  1. Total sample size of 81 patients are achieved during the study interval
  2. 12 months of follow-up for 81 patients are done.


Statistical method and data analysis

The data on categorical variables are shown as n (% of cases) and the data on continuous variables are presented as mean and standard deviation (SD) along with minimum-maximum range. The statistical comparison of the distribution of categorical variables across various post-procedure follow-ups is tested using Wilcoxon's signed-rank test.[5] The statistical comparison of the distribution of means of continuous variables across various postprocedure follow-ups is tested using repeated measures analysis of variance (RMANOVA).The underlying normality assumption was tested before subjecting the study variables to RMANOVA.[6] All the results are shown in tabular as well as graphical format to visualize the statistically significant difference more clearly.

In the entire study, the P < 0.05 are considered to be statistically significant. All the hypotheses were formulated using two-tailed alternatives against each null hypothesis (hypothesis of no difference). The entire data is statistically analyzed using Statistical Package for Social Sciences (SPSS ver 21.0, IBM Corporation, Armonk, NY, USA)[7] for MS Windows.

Ethics

Ethics committee approval was taken from the institute before the study.


  Observations and Result Top


Of 81 cases studied, 4 (4.9%) had age below 30 years, 10 (12.3%) had age between 30 and 39 years, 35 (43.2%) had age between 40 and 49 years, 22 (27.2%) had age between 50 and 59 years and 10 (12.3%) had age between 60 and 69 years [Table 2] and [Figure 1].
Table 2: Age distribution of cases studied in the study group

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Figure 1: Age distribution of cases studied in the study group

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The mean ± SD of age in the group was 47.0 ± 9.4 years and the minimum-maximum age range was 23–66 years.

Of 81 cases studied, 52 (64.2%) were male and 29 (35.8%) were female. The male to female gender ratio in the entire study group was 1.79:1.00 [Table 3] and [Figure 2].
Table 3: Gender distribution of cases studied in the study group

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Figure 2: Gender distribution of cases studied in the study group

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Of 81 cases studied, 35 (43.2%) had left side involved, 25 (30.9%) had right side involved and 21 (25.9%) had both left and right side involved [Table 4] and [Figure 3].
Table 4: Distribution of various characteristics of varicose veins among the cases studied in the study group

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Figure 3: Distribution of various characteristics of varicose veins

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Of 81 cases studied, 9 (11.1%) had duration <1 year, 53 (65.4%) had duration between 1 and 5 years, 15 (18.5%) had duration between 5 and 10 years and 4 (4.9%) had duration more than 10 years.

Of 81 cases studied, 6 (7.4%) had venous ulcer and 75 (92.6%) did not have venous ulcer.

Of 81 cases studied, 6 (7.4%) had comorbidity and 75 (92.6%) did not have any comorbidity.

Of 81 cases studied, 71 (87.7%) had the involvement of GSV, 4 (4.9%) had the involvement of SSV and 6 (7.4%) had both GSV and SSV involved [Table 5] and [Figure 4].
Table 5: Distribution of clinical findings for the involvement of veins among the cases studied in the study group

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Figure 4: Distribution of clinical findings for the involvement of veins among the cases studied in the study group

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Of 81 cases studied, 6 (7.4%) had ulcer and 75 (92.6%) did not have venous ulcer on clinical examination [Table 6] and [Figure 5].
Table 6: Distribution of clinical findings for venous ulcer among the cases studied in the study group

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Figure 5: Distribution of clinical findings for ulcer among the cases studied in the study group

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Of 81 cases studied, 17 (21.0%) had preoperatively poor QoL, 23 (28.4%) had fair QoL, 31 (38.3%) had good QoL and 10 (12.3%) had excellent QoL [Table 7] and [Figure 6].
Table 7: Distribution of preoperative quality of life score among the cases studied in the study group

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Figure 6: Distribution of preoperative quality of life score among the cases studied in the study group

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Of 81 cases studied, 21 (25.9%) had SF reflux, 47 (58.0%) had SF reflux + perforator, 4 (4.9%) had SP reflux + perforator and 9 (11.1%) had SF reflux + SP reflux + perforator on Doppler examination [Table 8] and [Figure 7].
Table 8: Distribution of outcome of color Doppler examination among the cases studied in the study group

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Figure 7: Distribution of outcome of colour Doppler examination among the cases studied in the study group

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Of 81 cases studied, 23 (28.4%) had Truncal varicosities procedure used and 56 (71.6%) had Truncal varicosities + Perforator procedure used [Table 9] and [Figure 8].
Table 9: Distribution of procedure among the cases studied in the study group

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Figure 8: Distribution of procedure among the cases studied in the study group

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Of 81 cases studied, none had new varicosities at 15 day and 1-month follow-up, 1 (1.2%) had new varicosities at 6-month follow-up and 3 (3.7%) had new varicosities at 12-months follow-up.

The distribution of incidence of new varicosities at postprocedure 1-, 6- and 12-months follow-up did not differ significantly compared to incidence at postprocedure 15-days (P > 0.05 for all) [Table 10] and [Figure 9].
Table 10: Distribution of incidence of new varicosities at 15 days, 1 month, 6 months, and 12 months postprocedure follow-up among the cases studied in the study group

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Figure 9: Distribution of incidence of new varicosities at 15-day, 1-, 6-, and 12-months postprocedure follow-up among the cases studied in the study group

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Of 81 cases studied, none had recurrence at 15-day, 1-, 6- and 12-months postprocedure follow-up.

The distribution of incidence of recurrence at postprocedure 1-, 6- and 12-months follow-up did not differ significantly compared to incidence at postprocedure 15-day follow-up (P > 0.05 for all) [Table 11] and [Figure 10].
Table 11: Distribution of incidence of recurrence at 15 days, 1 month, 6 months, and 12 months postprocedure follow-up among the cases studied in the study group

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Figure 10: Distribution of incidence of recurrence at 15-day, 1-, 6- and 12- months postprocedure follow-up among the cases studied in the study group

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Of 81 cases studied, 15 (18.5%) had residual varicosities at 15-day, 15 (18.5%) had residual varicosities at 1-month, none had it at 6- and 12-months follow-ups since they were given foam sclerotherapy at 6- and 12-months postprocedure follow-up.

The distribution of incidence of residual varicosities at postprocedure 6- and 12-months follow-up is significantly lower compared to incidence at postprocedure 15-day follow-up (P < 0.05 for all) [Table 12] and Figure 11].
Table 12: Distribution of incidence of residual varicosities at 15 days, 1 month, 6 months, and 12 months postprocedure follow-up among the cases studied in the study group

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Figure 11: Distribution of incidence of residual varicosities at 15-day, 1-, 6- and 12-months postprocedure follow-up among the cases studied in the study group

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Of 81 cases studied, 4 (4.9%) had pain, 6 (7.4%) had paresthesia and 71 (87.7%) did not have any complication at 15-day postprocedure follow-up.

Of 81 cases studied, 2 (2.5%) had pain, 1 (1.2%) had paresthesia and 78 (96.3%) did not have any complication at 1-month postprocedure follow-up.

Of 81 cases studied, none had any complication at 6- and 12-months postprocedure follow-up.

The distribution of incidence of postprocedure complication is significantly lower at postprocedure 1-, 6- and 12-month follow-up compared to incidence at postprocedure 15-day follow-up (P < 0.05 for all) [Table 13] and [Figure 12].
Table 13: Distribution of incidence of complications at 15 days, 1 month, 6 months, and 12 months postprocedure follow-up among the cases studied in the study group

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Figure 12: Distribution of incidence of complications at 15-day, 1-, 6- and 12-month postprocedure follow-up among the cases studied in the study group

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Of 81 cases studied, none had postopearative DVT at 15-day, 1-, 6- and 12-months postprocedure follow-up.

The distribution of incidence of postopearative DVT at postprocedure 1-, 6- and 12-months follow-up did not differ significantly compared to incidence at postprocedure 15-day follow-up (P > 0.05 for all) [Table 14] and [Figure 13].
Table 14: Distribution of incidence of postoperative deep venous thrombosis at 15 days, 1 month, 6 months and 12 months postprocedure follow-up among the cases studied in the study group

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Figure 13: Distribution of incidence of postoperative deep venous thrombosis at 15-day, 1-, 6- and 12-months postprocedure follow-up among

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The distribution of mean ± SD of QoL score at preopearative, 15-day, 1-, 6- and 12-months postprocedure follow-up was 119.27 ± 33.36, 158.06 ± 31.47, 163.86 ± 23.07, 168.74 ± 18.35 and 171.95 ± 19.55 respectively.

The distribution of mean QoL score at postprocedure 15-day, 1-, 6- and 12-months follow-is significantly higher compared to mean preprocedure QoL score (P < 0.001 for all) [Table 15] and [Figure 14].
Table 15: Distribution of mean quality of life score at preprocedure, 15 days, 1 month, 6 months, and 12 months postprocedure follow-up among the cases studied in the study group

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Figure 14: Distribution of mean quality of life score at pre-procedure, 15-day, 1-, 6- and 12-months postprocedure follow-up among the cases studied in the study group

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Of 81 cases studied, 17 (21.0%) had poor, 23 (28.4%) had fair, 31 (38.3%) had good QoL and 10 (12.3%) had excellent QoL at preprocedure study.

Of 81 cases studied, 4 (4.9%) had poor, 8 (9.9%) had fair, 12 (14.8%) had good QoL and 57 (70.4%) had excellent QoL at 15-day postprocedure follow-up.

Of 81 cases studied, 9 (11.1%) had fair, 11 (13.6%) had good QoL and 61 (75.3%) had excellent QoL at 1-month post procedurefollow-up.

Of 81 cases studied, none had poor, 1 (1.2%) had fair, 11 (13.6%) had good QoL, 69 (85.2%) had excellent QoL at 6-month postprocedure follow-up.

Of 81 cases studied, 1 (1.2%) had fair, 11 (13.6%) had good QoL, 69 (85.2%) had excellent QoL at 12-month post procedure follow-up.

The distribution of level of QoL is significantly better at postprocedure 15-days, 1-, 6- and 12-months follow-up compared to preprocedure QoL (P < 0.001 for all) [Table 16] and [Figure 15].
Table 16: Distribution of level of quality of life score at 15 days, 1 month, 6 months and 12 months postprocedure follow-up among the cases studied in the study group

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Figure 15: Distribution of level of quality of life score at pre-procedure, 15-day, 1-, 6- and 12-months postprocedure follow-up among the cases studied in the study group

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  Discussion Top


The standard treatment of varicose veins for many years has been surgical ligation and division of the affected vein, Trendlenberg operation. Outcomes have improved in recent years because of increased understanding of lower extremity venous anatomy but still failure rate are higher. In addition, surgical ligation and stripping is invasive, usually requiring general anesthesia and several weeks recovery before return to normal activities. In response to the need for a less invasive approach, numerous endovenous treatments have emerged over the past several years. The most notable endovenous advancements are the endovenous laser ablation (EVA). It has demonstrated clinical superiority to stripping and surgical ligation as well as significantly less postoperative pain and recovery time.

This study was a single centre observational prospective clinical study carried out to find the clinical effectiveness of endovenous laser ablation in varicose veins. This study was carried out in the department of general surgery and vascular surgery in Ruby Hall Clinic, Pune from August 2017 to 2019. Total of 81 patients admitted in Ruby Hall Clinic with varicose veins were treated with endovenous laser ablation technique as per the methodology already mentioned above, the following observations were made.

In this study, maximum patient with varicose vein were in 40–49 years age group.

This study has maximum of male patients treated with varicose veins. The male to female sex ratio in the entire study group was 1.79:1.00.Whereas study by Criqui MH, et al. in San Diego population study, varicose veins being observed in 28% of women and 15% of men.[8] Similarly, studies of McLafferty RB, et al., in the national venous screening program, uncomplicated varicose veins were seen in 23% of the participants, of whom 77% were women.[9] The apparent female predilection has been presumed to be due to the effect of pregnancy and possibly hormonal influences.

As shown in the [Table 4], patients presented with left sided varicose veins are more than right side or bilateral varicose veins.

Maximum patients presented with varicose vein has been suffering from < 5 years. Only 6 patients included in this study had ulcer with varicose veins which is similar to the study of Beebe-Dimmer et al., which suggests that only 1% of adult population presents with venous ulcer.[10]

In this study, distribution of superficial vein involvement is seen as, of 81 cases studied, 21 (25.9%) had SF reflux, 47 (58.0%) had SF reflux + perforator, 4 (4.9%) had SP reflux + perforator and 9 (11.1%) had SF reflux + SP reflux + perforator on Doppler examination. So, maximum patients were seen to have LSV incompetency. Whereas on doppler study, maximum patients had SF reflux + Perforator incompetence. Number of patients with combined truncal veins involvement along with perforators incompetence are more as compared to involvement of truncal veins alone.

This study shows the clinical effectiveness of 1470 nm laser fibre used for ablation of varicose veins under tumescent anaesthesia which shows the 100% closure rate of ablate vein at the end of 1 year. Similar study by Min et al. in 2003 establishes Endovenous laser ablation as an efficacious treatment with an 810-nm laser showed a 98.2% success rate and an ensuing closure rate of 93.4% at 2 years.[11] Proebstle et al. performed a study evaluating 1320 and 940 nm (15 and 30 W), lasers and reported favourable efficacy rates at 3 months of 90.3% with 940 nm, 15 W), 100% (940 nm, 30 W), and 97% (1320 nm).[12]

As this data indicate, EVA for the treatment of venous reflux is a well-tolerated, efficacious, and durable treatment option with 1470 nm LASER.

In this study, none had new varicosities at 15-day and 1-month follow-up, 1 (1.2%) had new varicosities at 6-month follow-up and 3 (3.7%) had new varicosities at 12-month follow-up.

There is no recanalization of ablated vein at all follow-ups. None had recurrence at 15-day, 1-month, 6- and 12-months postprocedure follow-up.

There were only 15 cases with residual varicosities postprocedure which were subsequently treated with foam sclerotherapy.

Only complication encountered post procedure are pain and paraesthesia, 87.7% did not have any complication at 15-day postprocedure follow-up, 96.3% did not have any complication at 1-month postprocedure follow-up and none had any complication at 6- and 12-months postprocedure follow-up.

DVT can be one of the dangerous complication of laser ablation but out of 81 cases studied, none had postoperative DVT at 15-day, 1-, 6- and 12-months postprocedure follow-up which is comparable with study of Min et al. results of the first large-scale study (499 limbs) using a laser with an 810-nm wavelength and noted that 24% of treated patients experienced bruising; notably absent were any cases of skin burns, paresthesia, and DVT.[11] Prophylactic anticoagulation and immediate ambulation is key in preventing DVT which is possible as LASER performed in tumescent anaesthesia.

QoL was assessed pre-operatively with maximum patients comes in the range showing good QoL. This QoL has been significantly improved post-procedure with subsequent follow-ups. At the end of the study, 85.2% had excellent QoL with no post-operative complications. Rasmussen et al.;[13] Kalteis et al.;[14] Lynch et al.;[15] Christenson et al.[16] showed no difference in QoL measures between stripping and ligation and EVLA, whereas study of Rautio et al.;[17] and Lurie et al.;[18] demonstrated an advantage for EVA over ligation and stripping in QoL.


  Conclusion Top


This observational prospective study shows the clinical effectiveness of endovenous laser ablation technique on varicose veins in terms of residual varicosities, new varicosities, recanalization rate, complications, and QoL.

Endovenous LASER ablation of the varicose vein has proven to be efficient technique for treating varicose veins as:

  1. There were least residual varicosities postprocedure which can be treated by the outpatient-basis procedure of foam sclerotherapy
  2. Development of new varicosities occurs late in follow-up
  3. There is zero recurrence rate of ablated veins through LASER
  4. Postoperative complications of pain and paraesthesia are minimal which is achieved by adequate amount of tumescent anaesthesia given by USG-guidance
  5. Dreaded complication of DVT is not recorded in any of the cases because of early ambulation
  6. There is significant improvement in QoL of patients from the start to the end of the study.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Proebstle TM, Lehr HA, Kargl A, Espinola-Klein C, Rother W, Bethge S, et al. Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: Thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles. J Vasc Surg 2002;35:729-36.  Back to cited text no. 1
    
2.
Perrin M, Creton D, Fassiadis N, Kato S. Endovenous treatment of lower-limb varices by laser and radiofrequency. Phlebolymphology 2005;337.  Back to cited text no. 2
    
3.
Proebstle TM, Sandhofer M, Kargl A, Gül D, Rother W, Knop J, et al. Thermal damage of the inner vein wall during endovenous laser treatment: Key role of energy absorption by intravascular blood. Dermatol Surg 2002;28:596-6.e2.  Back to cited text no. 3
    
4.
Pronk P, Gauw SA, Mooij MC, Gaastra MT, Lawson JA, van Goethem AR, 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;40:649-56.  Back to cited text no. 4
    
5.
Sunder Rao P, Richard J. An Introduction to Biostatistics: A Manual for Students in Health Sciences. 4th ed. New Delhi: Prentice Hall of India; 2006. p. 86-160.  Back to cited text no. 5
    
6.
Robert H Riffenburg. Statistics in Medicine. 2nd Edition, Walthum, Masachussetts: Academic press; 2005. p. 85-125.  Back to cited text no. 6
    
7.
Rosner B. Fundamentals of Biostatistics, 5th Edition. Duxbury: Cenage learning; 2000. p. 80-240.  Back to cited text no. 7
    
8.
Criqui MH, Jamosmos M, Fronek A, Denenberg JO, Langer RD, Bergan J, et al. Chronic venous disease in an ethnically diverse population: The san diego population study. Am J Epidemiol 2003;158:448-56.  Back to cited text no. 8
    
9.
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16]



 

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