Subfascial endoscopic perforator surgery with tumescent local anesthesia

Early Results and Feasibility of Incompetent Perforator Vein Ablation by Endovenous Laser Treatment

BACKGROUND

Dissection of incompetent perforator veins even when using the subfascial endoscopic perforator surgery technique is associated with substantial side effects.

OBJECTIVE

The objective was to evaluate the feasibility of endovenous laser ablation of incompetent perforator veins.

PATIENTS AND METHODS

A 940-nm diode laser and a Nd:YAG laser with 1,320 nm were used with laser fibers of 600 microm diameter. Perforators were accessed by ultrasound-guided puncture using 16- and 18-gauge cannulas, respectively. Fiber tips were placed below the fascia with at least 1-cm distance from the deep vein system. After administration of perivascular local anesthesia, laser energy was delivered in a pulsed fashion using laser power in the range between 5 and 30 W.

RESULTS

A total of 67 perforators were treated. Except one vein, all others were occluded at Day 1 after treatment. With 1,320 nm at 10 W, a median of 250 J (range, 103-443 J) was delivered resulting in significantly reduced posttreatment diameters to a mean of 69+/-23% (p=.0005). With 940 nm at 30 W, a median of 290 J (range, 90-625 J) was administered, showing no significant posttreatment diameter reduction. Side effects were moderate.

CONCLUSION

Ultrasound-guided endovenous ablation of incompetent perforators is safe and feasible.