[Feasibility of ambulatory endovenous laser for the treatment of greater saphenous varicose veins: one-month outcome in a series of 20 outpatients].

The purpose of this feasibility study was to demonstrate that endovenous laser can be a useful alternative to conventional surgery for ambulatory treatment of advanced varicose veins. We assessed an open, non-randomized series of patients treated in one center by the same operator. The study protocol was approved by the local ethics committee. Twenty patients with stage II or III varicose veins in the Porter classification gave their informed consent to participate in the study. The patients were treated with endovenous laser by the first author in the outpatient clinic of the Henri Mondor University Hospital vascular surgery department. All procedures were conducted under local anesthesia. A 980 nm laser diode optic fiber was introduced into the vein percutaneously. Laser beams were fired from the sapheno-femoral junction to just under the genu, withdrawing the fiber 3 mm every 1.5 sec. Clinical evaluation with a quality-of-life questionnaire and duplex-scan was performed at days 3, 8 and 30 post-op. Complete occlusion and retraction of the treated vein was observed at day 3 and 30, from the point of introduction to the sapheno-femoral junction in 18 of the 20 patients. The branches of the greater saphenous vein remained patent with physiological flow in the stump which remained patent 1 to 2 cm upstream from the sapheno-femoral junction. The length of the patent stump dependend on the level of the anterior or posterior branch. There were no adverse effects related to the local anesthesia. Pain was low to mild during treatment and the days following the procedure, requiring 8 tablets of acetominophen at most. Hematomas were minimal and had completely resolved by the end of the first month. No work stoppage was required for the 14 patients with occupational activities. There were no cases of deep or superficial vein thrombosis. Complete occlusion and retraction of the varicose vein at one month suggests this treatment has a long-lasting effect. Long-term evaluation is required. Treatment of advanced varicose veins with endovenous laser can be an alternative to surgical treatment providing the advantage of outpatient ambulatory treatment.