Whole-length great saphenous varicose veins thermochemical ablation, a novel technique: safety, efficacy, and mid-term follow-up results

Background
Despite all advances in the treatment of varicose veins, recurrence rates are still high, and multiple factors have been incriminated. This study aims to evaluate the safety and efficacy of whole-length great saphenous vein ablation, starting flush with the saphenofemoral junction down to the ankle, using a new technique combining laser and chemical ablations.
Patients and methods
A prospective study was conducted that included patients with varicose veins who presented to the Vascular Surgery Department, Dr. Soliman Fakeeh Hospital, KSA, in the period from May 2016 to February 2018. All patients were treated with endovenous laser ablation of the whole great saphenous vein starting flush at the saphenofemoral junction using radial fiber combining low-level laser energy with truncal injection sclerotherapy for the below-the-knee vein segment with adjusted linear endovenous energy density. Patients were followed up for 18 months. Chronic venous disease quality of life questionnaire-20 (CIVIQ-20) was obtained before treatment and after 6–12 months.
Results
This study included 125 patients (132 limbs), their mean age was 40.4±11.8 years, male to female ratio was 1 : 2.4, Clinical, Etiological, Anatomical, Pathological (CEAP) classification was 2–6, the presentation was bilateral in seven (5.6%) patients, technical success was achievable in 99.3% of patients, need for extra-truncal treatment at the same time of ablation (laser, injection, or phlebotomy) in 64 (48.5%) patients, postoperative deep vein thrombosis was seen in 0%, saphenous nerve injury was seen in one (0.7%) case, recanalization at 6–12–18 months was seen in two (1.5%) cases, and improvement in CIVIQ-20 from 71.25±9.6 to 32.4±4.6 and 29.7±1.2 was seen at 6 and 12 months, respectively.
Conclusion
The use of the radial laser fiber allows safe flush thermal ablation of the great saphenous vein, with the anticipated decrease in groin recurrence, combined with thermochemical ablation of the below-the-knee segment has promising result in short-term and mid-term follow-up.