Combining Endovenous Laser Ablation of the Saphenous Vein with Foam Sclerotherapy for Varicose Veins Is Safe and Effective in Treating 5500 Patients with Chronic Venous Insufficiency (CEAP C3-C6)

Introduction, Objectives, and/or Purpose: 1) Demonstrate efficacy and safety of hybrid technique on 5500 patients treated with EVLA and Sclerofoam.
2) Endovenous laser ablation (EVLA) is a commonly used minimally invasive procedure for treating incompetence of both great and small saphenous veins (GSV and SSV). To achieve a "no-scalpel" procedure in patients with chronic venous insufficiency (CVI, CEAP C3-C6), concomitant phlebectomies may be replaced by ultrasound-guided foam sclerotherapy (UGFS) into varicose tributaries. The aim of this study is to present the outcomes of EVLA+UGFS in patients with CVI secondary to varicose veins and saphenous trunk incompetence.

Methods: All consecutive patients with CVI treated with EVLA+UGFS from 2010 to 2022 were included. EVLA was performed using a 1470-nm diode laser, and UGFS was performed using the Tessari method. Patients were evaluated clinically and by duplex scanning at regular intervals to assess treatment efficacy and adverse reactions.

Results: 5500 patients with a mean age of 51.4 years were enrolled. A total of 3950 GSVs and 1550 SSVs were treated with EVLA+UGFS. The mean diameter was 7.5 mm for GSV and 5 mm for SSV. The LEED was adjusted from 80 J/cm to 140 J/cm. Atossisclerol from 0.5% to 1.5% was used for UGFS. No deep vein thrombosis or pulmonary embolism were detected during follow-up. Ecchymoses, transitory paraesthesia, palpable vein induration, and transient dyschromia were registered as minor side effects. Saphenous and tributaries closure rates at 30 days, 1 year, and 4 years were high.

Conclusion(s): EVLA+UGFS is a safe and effective minimally invasive procedure for treating CVI in patients with varicose veins and saphenous trunk incompetence. Further prospective randomized studies are needed to confirm the role of this combined therapy in such patients.