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abstracts

Feasibility and potential significance of prophy-

lactic ablation of the major ascending tributaries

in endovenous laser ablation (EVLA) of the great
saphenous vein: A case series

DR. LARS MUELLER; DR. JENS ALM

Abstract while a confluence of the tributary in the immediate prox-
imity to the SFJ had a negative impact (OR 0.2253; 95%
Background: CI [0.05456-0.7681]; p = 0.0253). An endothermal heat-
Recurrent varicosities after endovascular laser ablation induced thrombosis (EHIT) ≥ grade 2 was observed in
(EVLA) of the great saphenous vein (GSV) are frequent- three cases (1.1%).
ly due to varicose transformed, initially unsealed major
ascending tributaries of the saphenofemoral junction Conclusions:
(SFJ). Preventive ablation of these veins, especially the A co-treatment of the tributaries is feasible and could im-
anterior accessory saphenous vein, is discussed as an op- prove the technical success of EVLA if a prophylactic clo-
tion, along with flush occlusion of the GSV. However, few sure of these veins is desired, especially if their distance
related data exist to date. to the SFJ is short. Its effect on the recurrence rate needs
further research.
Methods:
A consecutive case series of 278 EVLA procedures of the Published: January 7, 2021
GSV for primary varicosis in 213 patients between May
and December 2019 was retrospectively reviewed. The PLoS One 2021 Jan 7;16(1):e0245275
ablations were performed with a 1470 nm dual-ring radial https://doi.org/10.1371/journal.pone.0245275
laser and always included flush occlusion of the GSV, and eCollection 2021
concomitant ablation of its highest ascending tributaries
by additional cannulation and ablation when this seemed
anatomically appropriate. The initial technical success,
comprising occlusion of the GSV and its major tributaries,
was set as the primary endpoint. Possible determinants
were explored using downstream multiple logistic regres-
sion analysis.

Results:
The early technical success was 92.8%, with the GSV oc-
cluded in 99.6% and the highest ascending SFJ tributary,
if present, in 92.4%. Additional ablations of ascending tri-
butaries were performed in 171 cases (61.5%), the latter
being associated with success (OR 10.39; 95% CI [3.420-
36.15]; p < 0.0001). Presence of anterior as opposed to
posterior accessory saphenous vein was another positive
predictor (OR 3.959; 95% CI [1.142-13,73]; p = 0.027),

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