Endovenous treatment for recurrent varicose veins deriving from the saphenofemoral and saphenopopliteal junction: technique, limits, and review of the available literature

Abstract

Introduction Endovascular techniques such as laser or radiofrequency are well established in the primary treatment of varicose veins and are supported by extensive literature and guideline recommendations. In contrast, there are only a small number of published studies on endovenous treatment for recurrences.

Methods In this paper, the existing literature is first analysed. Subsequently, own experiences and techniques for endovenous treatment of recurrence are presented and possible limitations of the method are discussed.

Results In the Pubmed search, 7 relevant papers on observational studies were found. One paper presented the results of a prospective randomised study comparing radiofrequency versus surgery. In most published studies, case selection was performed, with the presence of a longer truncal vein segment being a prerequisite for thermal ablation. The results regarding morbidity and closure rates are favourable, although long-term data are lacking. In our own practice, recurrences are regularly treated with endovenous therapy, mainly with the latest radial lasers. We also treat lesions that do not have a straight vein or only have a short segment of straight veins, for example, stumps or neovascularisations of the former saphenofemoral or saphenopopliteal junction. Technical tools that enable effective ablation of a recurrence in most cases are presented in this paper. Particular emphasis is placed on the direct puncture of a stump or shorter vein segments, as well as the threading in the context of the puncture of tortuous vein segments. Anatomical constellations in which endovenous thermal ablation may not be the method of first choice should be discussed. Examples of this are extremely tortuous, severely dilated vein segments, or very diffuse, small-calibre neovascularisations.

Conclusion In summary, endovenous thermal ablation for recurrent varicose veins appears to be an effective treatment modality that works even in anatomically challenging situations with short stumps and tortuous vein courses. However, a broader study activity on this would be desirable.

Key words

varicose - laser ablation - EVLA - recurrence - duplex ultrasound

Schlüsselwörter

Varizen - Laserablation - EVLA - Rezidiv - Duplexsonografie

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