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original article

On the topic of REVAS, there are many scientific publica- ally to the SFJ. With this technique not only do we prevent
tions and reviews. Many of these publications conclude the stump from even appearing, we can also successfully
that REVAS most often originate from the stump of the remove stumps as short as 1cm and, in that way, help
saphenous vein, if crossectomy is not performed. The patients with recurrent varicose veins.
first centimeter from the SFJ of the great saphenous vein That is exactly what I decided to start doing. By pla-
can have as many as ten tributaries! That is a very high cing the tip of the laser as close as 0.1mm away from the
number of possible weak points for venous insufficiency. common femoral vein, I could perform a crossectomy with
SFJ is the most complex and proximal point of the the laser and still not be worried about deep vein throm-
superficial venous system of the leg and also it’s main bosis.
crossroad. The tributaries that form the junction include The risk doesn’t increase as the precision of today’s
the superficial iliac vein, superficial epigastric vein, then, laser is measured in microns. The equipment of choice is
from the pelvis, obturator vein and superficial and deep always the biolitec ELVeS Radial fiber. >fig. 4
pudendal veins, followed by the anterior and medial ac-
cessory saphenous veins, which are often found inside
a fascial fold, and finally a large number of submillimeter
veins that drain the surrounding lymphatic nodes. What
were previously thought to be neovascularizations are
actually dilations of these small veins caused by increa-
sed pressure if a GSV stump is left.
First laser techniques and protocols indicated that fig. 4 > ELVeS Radial 2ring Fiber © biolitec
the starting point of ablation should be 2cm away from
the SFJ. The reason for this was obviously fear of deep
vein thrombosis and, of course, pulmonary embolism. This was a major breakthrough and since I started doing
While the fear is well-founded, and we should always my operations this way, I never looked back. My team is
be wary of such complications, the biolitec ELVeS Radial happier, my patients are happier thanks to the fewer re-
fibers have proven to be very safe in this regard. Since the currences happening, and naturally, I am happier as well.
radial fiber shoots laser beams at 90 degrees, perpen- Laser crossectomy technique is performed by introdu-
dicular to the laser, there is no fear of propagation into cing the laser fiber into GSV and placing the laser tip as
the deep vein, even if the ablation starts very proxim- close as 0.1mm to the line of CFV. > fig. 5a, fig. 5b

➋ ➊

© Dr. Petar Dragić SFJ border ➊ Anterior Acc. Vein ➋ Epigastric Vein © Dr. Petar Dragić

fig. 5a > Starting point of ablation of SFJ (ultrasound) fig. 5b > Starting point of ablation of SFJ (illustration)

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