Anatomical variants of recurrent varicose veins of the lower extremity after endovenous laser ablation of the great saphenous vein

Introduction. Relapses is an important criterion that is used to determine the effectiveness of any treatments of varicose veins of the lower extremity (VVLE). However, only a few studies in the literature are devoted to the distant outcomes of endovenous laser coagulation (EVLC) using the 1470 nm laser.
Aim. To identify anatomical variants of VVLE relapses after EVLC using the 1470 nm laser, study the frequency of relapses, and determine the factors affecting the risk of relapses.
Materials and methods. A total of 358 EVLC with 78 sonographic recurrences were performed during a 5-year observation period. EVLC was performed using the 1470 nm laser system, and radial light guides with a 400-μm-diameter. At 1, 3, 6, 12, 24, 36, 48, 60 months after EVLC, a follow-up ultrasound examination was carried out. A visual detection of varicose vein was classified as a clinical recurrence. Patients without visually detected varicose tributaries and trunk, but with recanalized sections of the great saphenous vein (GSV) trunk, an incompetent GSV trunk in the lower leg, tributaries and perforators of the operated extremity were considered to be sonographic recurrences. Statistical analysis was performed with IBM SPSS 22 statistic software package (USA). The analysis of variance test (ANOVA) was used to determine the statistical significance of observed differences in mean value, and Pearson's chi-squared (χ2) test in Fisher's exact solution to determine frequencies. Differences were considered statistically significant at p < 0.005.
Results. The main anatomical variants of sonographic recurrences included incompetent ostial tributaries (n = 20), segmental recanalization of femoral perforator GSV trunk (n = 21), perforators in the upper third leg (n = 10), perforators in the middle and lower third leg (n = 22).
Discussion. Endovascular laser obliteration of the intact anterior accessory great saphenous vein (AAGSV) needs further studies. It is not recommended to ligate perforators with a diameter < 3.5 mm, while coagulation of perforators that have direct drainage to the great or small saphenous vein trunk with a high energy flow needs further studies.
Conclusion. The most of sonographic VVLE recurrences occur within 1 to 4 years after endovascular laser treatment and are associated with the development of valve insufficiency in previously intact saphenous and/or perforator veins followed by segmental recanalization of the obliterated GSV trunk.

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