RESULTS TO 5 YEARS AFTER ENDOVENOUS LASER TREATMENT

Introduction: To refer and to discuss the appearance of recurrent varicose veins after many years from the endovenous laser treatment of the refluent saphenous axis. Patients and methods: 191 laser procedures have been carried out in the period between December 2001 and June 2009 at the Center of Phlebolymphology of the Siena University for the treatment of 188 patients with varicose veins of the lower limbs. 145 patients are females and 46 males, ranging in age between 22 and 80 years. The superficial chronic venous insufficiency was caused by the incompetence of the saphenofemoral junction (SFJ) and the reflux of the great saphenous vein (GSV), as demonstrated by duplex scanner. All patients were operated under local anesthesia and sonographic guidance. A diode laser of 810 nm has been used in the first 71 procedures and a diode laser of 980 nm in the following 120 procedures. The fiber laser is introduced for transcutaneous way or after small surgical cutaneous incision from the bottom to the top with the tip that arrives to 2 cm from the saphenofemoral junction, in way to leave effluent the epigastrica vein. The employed parameters have been 12- 14 watt of power with 3 impulses of 1 second according to repeated after an interval of 1 second every cm of length of the vein, thus to obtain a fluence of approximately 40 joule for cm. Results: The immediate obliteration of the saphenous axis has been had in 182 cases (95%). The ricanalization of the great saphenous vein has been documented in the instrumental follow up in 11 patients (10,2%) at 3 years from the treatment, in 9 (12%) at 4 years and in 9 (25,7%) after 5 years. Conclusion: The endovenous laser treatment for the therapy of varicose veins of the lower limbs is a simple procedure, poor invasive, that it can be performed in outpatient or Day Surgery regime without increase of the costs of stay in hospital. Its effectiveness currently is put in argument from the possibility that a recurrent varicose veins appears at distance of years from the treatment with ricanalization of the saphenous axis, even if in absence of symptomatology. In our experience this possibility has evidenced in the clinical and instrumental follow up of the patients operated after 5 years in a percentage that exceeds the 20%.