Long Term Risk of Clinical Recurrence following Endovenous Laser Ablation of the Great Saphenous Vein with 810 nm Laser Bare Tip Fibre: An Observational Study.

Abstract

Varicose veins are highly prevalent and most patients present with great saphenous vein (GSV) reflux. Treatment of truncal venous reflux is the cornerstone in the management of C2 disease. Endovenous laser ablation (EVLA) is widely accepted as the preferred treatment. This study aimed to estimate the long term risk of clinical recurrence in the treated leg after successful EVLA of the GSV. This single centre, observational study included patients with C2 varicose veins in whom refluxing GSV was diagnosed. EVLA was performed from 10 - 15 cm below the knee and occlusion was confirmed with duplex after 3 months. Additional treatment after EVLA was always in a staged approach. Clinical recurrence was defined as a patient actively seeking re-treatment at least 6 months after EVLA for symptoms due to varicose veins in the treated leg. Recurrence was identified through electronic health records or, when not documented, by telephonic survey. The study included 543 patients with a median follow up of 6.0 (interquartile range 1.3, 10.3) years. The mean age at treatment was 52.8 ± 13.3 years and 79.2% were women. Clinical recurrence occurred in 210 patients, with an estimated 10 year recurrence rate of 47.6% (95% confidence interval 42.5 - 52.1%). Additional therapy within 6 months following EVLA was associated with a hazard ratio of 1.31 (95% confidence 0.99 - 1.72; p = .055), adjusted for age and sex. Clinical recurrence after EVLA of the GSV occurred in approximately half of patients within 10 years of the procedure, exceeding rates reported with concomitant additional treatment and EVLA of the entire refluxing GSV. The association between early additional therapy and a higher recurrence rate suggests that it may indicate an unmet therapeutic need.