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Endovenous laser treatment of the small saphenous vein: results and complications

Kathleen Gibson, MD, Brian Ferris, MD and Daniel Pepper, MD
Lake Washington Vascular Surgeons, Lake Washington Vascular Surgeons,Bellevue, WA

Objective: To assess the efficacy and rate of complications of endovenous laser treatment of the small saphenous vein (SSV).
Methods: One hundred seventy- two limbs (151 patients) with duplex documented SSV incompetence were treated with laser endovenous ablation using a 900nm diode laser over a 15 month period of time. Duplex ultrasound examinations were performed on the day of the procedure, within the first week and at three months. Clinical examinations were performed at two weeks and six weeks. Patients were assessed for deep venous thrombosis (DVT), nerve injury, and resolution of symptoms.
Results: All patients had successful occlusion of the SSV after initial treatment, and in patients who returned for follow-up study (58) 95% remained closed at 3 months. Three patients (1.7%) had numbness at the lateral malleolus at six-week clinical follow-up. No patients had a DVT detected at the initial duplex, but eleven patients (6.4%) had a DVT defined as a tail of thrombus protruding into the popliteal vein at the one-week follow-up exam. Eight patients were treated with between three days to three months of unfractionated heparin and coumadin, and there were no DVT extensions or pulmonary emboli. Female gender and lack of any branch veins at the saphenopopliteal junction were the only factors that significantly predicted DVT. Fifty-six (33%) of patients had skin changes or ulceration (CEAP class 4, 5, or 6) All but two patients had resolution of these symptoms.
Conclusions: Intermediate term results of SSV treatment with endovenous laser ablation demonstrate the technique is effective at eliminating SSV reflux and affording symptomatic relief. Incidence of nerve injury is low, but the incidence of DVT is higher than reported for the great saphenous vein.