Study of risk factors for recurrence of varicose veins after endovenous laser obliteration of the great saphenous vein to determine indications for crossectomy

Introduction. Currently, it is recommended to use lasers with a wavelength of 1470, 1560, 1940 nm, coupled with radial light guides, for EVLO.

Aim. To study the risk factors for recurrence of varicose veins after endovenous laser obliteration of the great saphenous vein to determine the indications for crossectomy.

Materials and methods. The study included 150 patients with varicose veins who underwent laser EVLO. There were 112 women (74.6%) and 38 (26.4%) men. The median age was 46.3 ± 9 years. Alaser with a wavelength of 1 470 nm and radial light guides were used. Phenotypic features characterizing undifferentiated connective tissue dysplasia were investigated. The study group included 75 patients who underwent crossectomy, and 33 (44%) had dysplasia. 75 patients made up the comparison group – without crossectomy, 36 (48%) – had dysplasia.

Results and discussions. During 36 months of follow-up, 4 (5.3%) patients in the study group developed a recurrence of varicose veins and 14 (18.6%) in the comparison group (p = 0.0001). Studies conducted using the Cox regression method made it possible to identify independent risk factors for the development of disease recurrence: the presence of dysplasia, the number of collaterals in the zone of the sapheno-femoral anastosis, the diameter of the great saphenous vein, the diameter of v. epigastrica superficialis, as well as the thickness of the wall of the great saphenous vein. An integral assessment of independent risk factors for the development of recurrence made it possible to propose a method for determining indications for crossectomy during EVLO of the great saphenous vein.

Conclusions. Risk factors for recurrence of varicose veins after EVLO of the great saphenous vein were identified, which made it possible to start developing a method for determining indications for crossectomy to reduce the number of recurrences of the disease.

Acknowledgment. The study was carried out with the financial support of Saratov State Medical University as part of the scientific project NoSSMU-2022-005, the support did not affect the results of the study.

1. Стойко ЮМ, Мазайшвили КВ. Эндовенозная лазерная облитерация. М.: Ленанд; 2020. 208 с.

2. Setia A, Schmedt CG, Sroka R. Endovenous laser ablation using laser systems emitting at wavelengths > 1900 nm: a systematic review. Lasers Med Sci. 2022;37(9):3473–3483. https://doi.org/10.1007/s10103-022-03609-w.

3. Raskin VV, Semenov AYu, Kurginyan KhM. Endovenous laser obliteration in the prevention of recurrence of varicose veins in the anterior saphenous vein pool. Profilakticheskaya Meditsina. 2020;23(3):98–103. (In Russ.) https://doi.org/10.17116/profmed20202303198.

4. Kamaev AA, Bulatov VL, Vakhratyan PE, Volkov AM, Volkov AS, Gavrilov EK et al. Clinical recommendations. Varicose veins. Flebologiya. 2022;16(1):41–108. (In Russ.) https://doi.org/10.17116/flebo20221601141.

5. O'Donnell TF, Balk EM, Dermody M, Tangney E, Iafrati MD. Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. J Vasc Surg Venous Lymphat Disord. 2016;4(1):97–105. https://doi.org/10.1016/j.jvsv.2014.11.004.

6. Gauw SA, Lawson JA, van Vlijmen-van Keulen CJ, Pronk P, Gaastra MT, Mooij MC. Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg. 2016;63(2):420–428. https://doi.org/10.1016/j.jvs.2015.08.084.

7. Pavei P, Spreafico G, Bernardi E, Giraldi E, Ferrini M. Favorable long-term results of endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber. J Vasc Surg Venous Lymphat Disord. 2021;9(2):352–360. https://doi.org/10.1016/j.jvsv.2020.06.015

8. Chernookov AI, Kuznetsov MR, Kandyba SI, Dolgov SI, Atayan AA, Ramazanov AA. Prevention of the development of varicose vein relapses in patients with true doubling of the great saphenous vein. Ambulatornaya Khirurgiya. 2022;19(2):30–35. (In Russ.) https://doi.org/10.21518/1995-1477-2022-19-2-30-35.

9. Chernookov AI, Kandyba SI, Silchuk ES, Dolgov SI, Atayan AA, Lebedeva YuN, Ramazanov AA. Endovascular laser coagulation in varicose vein relapses in the lower extremities. Laser Medicine. 2022;26(2):8–14. (In Russ.) https://doi.org/10.37895/2071-8004-2022-26-2-8-14.

10. Flessenkämper I, Hartmann M, Hartmann K, Stenger D, Roll S. Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatment of great saphenous varicose veins: Results of a multicentre randomised controlled trial with up to 6 years follow-up. Phlebology. 2016;31(1):23–33. https://doi.org/10.1177/0268355514555547.

11. Chandler JG, Pichot O, Sessa C, Schuller-Petrović S, Osse FJ, Bergan JJ. Defining the role of extended saphenofemoral junction ligation: a prospective comparative study. J Vasc Surg. 2000;32(5):941–953. https://doi.org/10.1067/mva.2000.110348.

12. Flessenkämper I, Hartmann M, Stenger D, Roll S. Endovenous laser ablation with and without high ligation compared with high ligation and stripping in the treatment of great saphenous varicose veins: initial results of a multicentre randomized controlled trial. Phlebology. 2013;28(1):16–23. https://doi.org/10.1258/phleb.2011.011147.

13. Disselhoff BCVM, Kinderen DJ, Kelder JC, Moll FL. Five-year results of a radomised clinical trial of endovenous laser ablation of the great saphenous vein with and without ligation of the saphenofemoral junction. Eur J Vasc Endovasc Surg. 2011;41(5):685–690. https://doi.org/ 10.1016/j.ejvs.2010.12.014.

14. Vakhitov MSh, Ulimbashev ZM, Ryzhov AN, Bykov MA, Danilchenko OV, Tsibin AYu, Semenov DY. Genesis of great saphenous vein obliteration and its clinical manifestations after endovenous laser coagulation combined with crossectomy during the varicose vein treatment. Vestnik Khirurgii imeni I.I. Grekova. 2013;172(1):16–19. (In Russ.) Available at: https://www.vestnik-grekova.ru›jour/article/view/754/755.

15. Ahadov RA, Sazonov AB, Kitachev KV, Sizenko VV, Khubulava GG. The prevention of pulmonary embolism following endovenous laser coagulation of varicose veins of the lower limbs. Vestnik Khirurgii imeni I.I. Grekova. 2018;177(1):16–19. (In Russ.) https://doi.org/10.24884/0042-4625-2018-177-1-16-19.

16. Huang Y, Zhang D, Zhou C, Zhang Y, Shi C, Chen Q. The first meta-analysis research on the effects of endovenous laser ablation combined with sapheno-femoral junction high ligation of the great saphenous vein. Lasers Med Sci. 2023;38(1):175. https://doi:10.1007/s10103-023-03833-y.

17. Demidov RO, Lapshina SA, Yakupova SP. Connective tissue dysplasia: modern approaches to clinic, diagnosis and treatment. Practical Medicine. 2015;4(2):37–40. (In Russ.) Available at: https://docs.yandex.ru/docs/view?url=ya-disk-public%3A%2F%2F4zsSex%2ByFP1gKUu5hn1lw32cmAmijY00GRwbWgU%2BWeE%3D&name=Obl%204-2.pdf.

18. Martynov A, Nechaeva G. National Recommendations of the Russian Scientific Medical Society of Therapists for the Diagnosis, Treatment and Rehabilitation of Patients with Connective Tissue Dysplasia. Medical News of North Caucasus. 2016;11(1):2–76. (In Russ.) https://doi.org/10.14300/mnnc.2016.11001.

19. Koichubekov BK, Sorokina MA, Mkhitaryan KE. Determination of Sample Size in Planning Scientific Research. International Journal of Applied and Basic Research. 2014(4):71–74. (In Russ.) Available at: https://applied-research.ru/ru/article/view?id=5074.

20. Сенин АА, Ватащук В, Царев ОА. Программа для 2d визуализации анатомии вен нижних конечностей на основе данных ультразвукового исследования. Свидетельство о регистрации программы для ЭВМ RU 2024615469, 07.03.2024. Режим доступа: https://fips.ru/EGD/4283d269-910e-42c6-b416-c0b25e21d120.

21. Tsarev OA, Zakharov NN, Senin AA, Korchakov NV. The effect of undifferentiated connective tissue dysplasia on the clinical course of varicose disease and thrombophlebitis of varicose veins after crossectomy. Saratov Journal of Medical Scientific Research. 2022;18(1):38–41. (In Russ.) Available at: https://ssmj.ru/2022/1/38.