Progression And Recurrence Of Vein Disease In Patients Treated With Endovenous Laser Ablation: One Year Experience

Thursday, 20 September 2007

Start 10:30am

Salon 1

Duration: 10mins

King JT1*
1Vein Clinics of America, Oak Brook, IL, USA

Aim
There is now abundant data regarding the incidence of recurrence of reflux at the SFJ and SPJ after endovenous laser treatment (ELT). Tracts of recurrent flow occur in veins that have been treated with laser at sites other than the junctions. There is little data concerning how often this occurs, when it occurs, and what causes it to occur.

Methods
A retrospective analysis of 96 cases (112 veins) treated with ELT (980 nm: 60 and 1320 nm: 48). Complete Duplex ultrasound scanning was done at 1, 3, 6, and 12 months and any reflux (>0.5 sec.) was noted. New vein disease (progression), recurrent or continued flow through a segment of previously lased vein (recurrence), and continued or new branch vein reflux seen on ultrasound at any follow-up evaluation was treated with ultrasound-guided foam sclerotherapy. 

Results 
Recurrence at one month was due to incompetent perforators in the thigh (IP1) 7 times, incompetent perforators in the calf (IP2) 7 times, the sapheno-femoral junction (SFJ) 14 times, the sapheno-popliteal junction (SPJ) 1 time, and antegrade flowing epifascial tributaries (BF) 38 times. At three months, the results were IP1: 8, IP2: 13, SFJ: 13, SPJ: 2, and BF: 24. At six months, the results were IP1: 5, IP2: 4, SFJ: 16 SPJ: 1, and BF: 12. At twelve months, the results were IP1: 3, IP2: 2, SFJ: 4, SPJ: 1, and BF: 6. 

Progression at one month was not due to IP1, was due to IP2 five times, was not due to the SFJ, was due to the SPJ 1 time, and was due to antegrade flowing epifascial tributaries (BF) 2 times. At three months, the results were IP1: 1, IP2: 4, SFJ: 0, SPJ: 4, and BF: 4. At six months, the results were IP1: 0, IP2: 1, SFJ: 0 SPJ: 1, and BF: 1. At twelve months, there were no episodes of progression of vein disease as a result of any of these sources. 

Conclusion
In the first year after endovenous laser ablation, recurrence of reflux in the treated vein occurs far more commonly than progression of new disease (171:23) but the incidence of both decreases over time. New incompetent perforators in the thigh and calf and new SFJ incompetence accounted for all of the progression of new vein disease seen in previously untreated veins. Progression of new disease was seen more commonly at three months of follow-up than at any other time. Incompetent perforators in the thigh (13.5%) and calf (15.2%) and antegrade flowing branch (feeder) veins (46.8%) are a greater source of recurrence in previously lased veins than failure to close or reopening of the SFJ (21.6%) or SPJ (2.9%). Assurance of long lasting treatment success will depend on careful Duplex ultrasound follow-up, especially at three months, looking for incompetent perforators and feeders along the course of the treated veins, as well as evaluation of the treated junctions.