The first 1000 cases of Italian Endovenous-laser Working ...

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The first 1000 cases of Italian Endovenous-laser Working ...

  1. 1. The first 1000 cases of Italian Endovenous-laser Working Group (IEWG).Rationale, and long-term outcomes for the 1999-2003 period.1: Int Angiol. 2006 Jun;25(2):209-15. • Agus GB, • Mancini S, • Magi G; • IEWG.Institute of Vascular Surgery and Angiology, University of Milan, Milan, Italy. giovanni.agus@unimi.itAIM: The innovations for disease management need to be thoroughly evaluated so that their benefits andpotential downsides can be compared with the already existing approaches. Endovascular laser (EVL)treatment for varicose veins offers today several advantages over surgical standard stripping. The ItalianEndovenous-laser Working Group (IEWG) is a homogeneous group of surgeons and phlebologists who havebeen using EVL since 1999 and has undertaken to examine EVL in a multicenter study starting from a welldefined rationale, with the benefit of a single protocol to use. METHODS: In a cooperative, multicenter,clinical study, 1076 limbs in 1050 patients, mean age of 54.5 years, 241 males and 809 females affected bychronic venous insufficiency (CVI) were considered eligible for surgery and stratified by CEAP classification in afour-year period (January 1999 December 2003). Inclusion criteria were insufficiency of the great and/or smallsaphenous vein at various levels, beyond those accessory saphenous trunks with incompetence in thesaphenofemoral junction. In all cases truncular reflux apparead up on duplex scan examination, with orwithout associated varicosities. All the patients underwent a surgery on the basis of the clinical assessment.All the centres involved performed treatment in conformity with the Food and Drug Administration (FDA)validated procedure, using an endo-laser venous system kit with a 810-980 nm diode. Duplex scan wasperformed in all patients after 36 months with very few lost to follow-up cases. RESULTS: In the immediatepostoperative period the results have been impressive, with a very effective closure of incompetent greatsaphenous vein and the other treated varicose veins (the early occlusion rate has been 99%). Majorcomplications have not been detected: in particular, no deep venous thrombosis (DVT) evaluated duplexultrasound. The patients acceptability and satisfaction regarding the procedure, have been measured bymeans of a questionnaire on the quality of life, and the result was 96.7%. After 36 months, the total occusionrate of saphenous trunks has been 97%. CONCLUSIONS: The first important Italian experience with EVL basedon preoperative, perioperative and postoperative duplex control and which is also based on the patientssatisfaction at mid/long-term has indicated some advantages over the standard treatment with the strippingmethod. In terms of reduced postoperative pain, shorter sick leave, a faster resumption of the normalactivities, and, in particular, the total absence of DVT, we can conclude that EVL is a good solution for allpatients with anatomic and hemodinamic patterns for saphenous vein surgery.PMID: 16763541 [PubMed - indexed for MEDLINE]
  2. 2. Endovenous laser therapy of the incompetent great saphenous vein.[Article in English, Italian]1: Radiol Med (Torino). 2006 Feb;111(1):85-92. • Petronelli S, • Prudenzano R, • Mariano L, • Violante F.UOS di Angiografia e Radiologia Interventistica, Ente Ecclesiastico, Ospedale Regionale "Miulli", Via MaselliCampagna, 1-70021 Acquaviva delle Fonti, Bari, Italy. spetro@tiscali.itPURPOSE: The aim of this study was the development of a new, even less invasive technique, for thetreatment of varicose veins of the lower limbs than traditional surgery (ligation with stripping of thesaphenous vein). MATERIALS AND METHODS: The new interventional radiological procedure uses the 810- to980-nm endovascular laser fibre proposed by Min et al. Our technique involves the superselectivecatheterisation of the great saphenous vein under fluoroscopy with contralateral venous access achieved byperforming iliac crossover. Retrograde and anterograde phlebographies are performed with a needle cannulapositioned in the dorsum of the foot. This enables accurate venous mapping during the procedure of laserphotothermolysis. We treated 52 patients between June 2003 and June 2004, with a percentage ofrecanalisation of 7.5% at 1 year. RESULTS AND CONCLUSIONS: The contralateral approach allows greatercontrol over the entire procedure, with a reduction in potential risks in relation to the saphenofemoraljunction given that, unlike in the technique proposed by Min et al. the tip of the laser is directed at all timestowards the saphenous vein and never towards the femoral vein. This more radical procedure offers asignificant reduction in the possibility of relapse of varicose disease of the saphenofemoral junction.PMID: 16623308 [PubMed - indexed for MEDLINE]
  3. 3. Is there recanalization of the great saphenous vein 2 years after endovenouslaser treatment? 1: J Endovasc Ther. 2005 Dec;12(6):731-8. • Disselhoff BC, • der Kinderen DJ, • Moll FL.Department of Surgery, Mesos Medical Centre, Utrecht, The Netherlands. bcvmdisselhoff@mesos.nlPURPOSE: To report the 2-year single-center results of endovenous laser treatment (EVLT) for reflux in thegreat saphenous vein (GSV). METHODS: From January 2002 to January 2003, 85 symptomatic patients (56women; mean age 49 years, range 27-80) underwent EVLT in 100 limbs. All patients were symptomatic, andthe majority (67, 79%) had CEAP clinical class C2 venous disease. After treatment, they were monitored byclinical evaluation and duplex imaging. RESULTS: The initial treatment was completed in 93 limbs.Complications consisted of bruising (31%), tightness (17%), pain (14%), induration (2%), and superficialthrombophlebitis (2%). No severe complications were observed. Over a mean follow-up of 29 months (range24-37), 3 patients died and 14 were lost to follow-up, leaving 88 (95%) and 76 (82%) limbs available forimaging surveillance at 1 and 2 years, respectively. At 3 months, treatment was anatomically successful in 84%of cases (78 complete occlusion, 7 partial occlusion, and 8 nonocclusion) and functionally successful in 89%(83 no reflux, 10 reflux). All technical failures and 73% (n=11) of the treatment failures occurred in the firsthalf of the studied population, indicating a learning curve effect (p=0.015). Mean energy delivered per unitlength was 39+/-8 J/cm (range 25-65) for successful treatment (n=78) and 30+/-10 J/cm (range 21-50) forfailed treatment (n=15). No recanalization or recurrent GSV reflux after anatomically and functionallysuccessful treatment was observed in 73 and 61 limbs at 1 and 2-year follow-up, respectively. CONCLUSIONS:EVLT is a feasible, safe, and fast procedure for eliminating GSV reflux and has excellent cosmetic results.Despite the learning curve, we believe that the treatment results are promising. When successful treatment isachieved by EVLT, a prospective follow-up of 2 years demonstrates durable results.PMID: 16363903 [PubMed - indexed for MEDLINE]
  4. 4. Lower energy endovenous laser ablation of the great saphenous vein with980 nm diode laser in continuous mode. 1: Cardiovasc Intervent Radiol. 2006 Jan-Feb;29(1):64-9 • Kim HS, • Nwankwo IJ, • Hong K, • McElgunn PS.The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School ofMedicine, Baltimore, MD 21205, USA. sikhkim@jhmi.eduPURPOSE: To assess clinical outcomes, complication rates, and unit energy applied using 980 nm diodeendovenous laser treatment at 11 watts for symptomatic great saphenous vein (GSV) incompetence andreflux disease. METHODS: Thirty-four consecutive ablation therapies with a 980 nm diode endovenous laser at11 watts were studied. The diagnosis of GSV incompetence with reflux was made by clinical evaluation andduplex Doppler examinations. The treated GSVs had a mean diameter of 1.19 cm (range 0.5-2.2 cm). Thepatients were followed with clinical evaluation and color flow duplex studies up to 18.5 months (mean 12.19months +/- 4.18). RESULTS: Using 980 nm diode endovenous laser ablation in continuous mode, 100%technical success was noted. The mean length of GSVs treated was 33.82 cm (range 15-45 cm). The meanenergy applied during the treatment was 1,155.81 joules (J) +/- 239.50 (range 545.40-1620 J) for a meantreatment duration of 90.77 sec +/- 21.77. The average laser fiber withdrawal speed was 0.35 cm/sec +/-0.054. The mean energy applied per length of GSV was 35.16 J/cm +/- 8.43. Energy fluence, calculatedseparately for each patient, averaged 9.82 J/cm(2) +/- 4.97. At up to 18.5 months follow-up (mean 12.19months), 0% recanalization was noted; 92% clinical improvement was achieved. There was no majorcomplication. Minor complications included 1 patient with hematoma at the percutaneous venotomy site, 1patient with thrombophlebitis on superficial tributary varices of the treated GSV, 24% ecchymoses, and 32%self-limiting hypersensitivity/tenderness/"pulling" sensation along the treatment area. One patient developedtemporary paresthesia. Four endovenous laser ablation treatments (12%) were followed by adjunctivesclerotherapies for improved cosmetic results. CONCLUSION: Endovenous laser ablation treatment of GSVusing a 980 nm diode laser at 11 watts in continuous mode appears safe and effective. Mean energy appliedper treated GSV length of 35.16 J/cm or mean laser fluence of 9.82 J/cm(2) appears adequate, resulting in 0%recanalization and low minor complication rates.PMID: 16283576 [PubMed - indexed for MEDLINE]
  5. 5. Hyun K. Kim, Sr., MD., PhD.1, Hark J. Kim, Sr., MD, PhD1, Jae H. Shim, Sr., MD1, Man J. Baek, Sr., MD, PhD1,Young H. Choi, Sr., MD, PhD1, Hyung M. Kim, Sr., MD, PhD2.1Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea, 2Anam Hospital, Korea UniversityMedical Center, Seoul, Republic of Korea.Objectives: Endovenous laser treatment (EVLT) is an effective alternative to stripping of varicose veininvolving the long and small saphenous veins. However, for the treatment of truncal tributary varicosities,ambulatory phebectomy or sclerotherapy is usually recommended. In the present study, authors performedonly EVLT for correction of truncal varicosities and evaluate its safety and effectiveness.Methods: 132 patients (76 male, 56 female; combination group) with varicose vein were treated withcombined endovenous laser obliteration followed by ambulatory phlebectomy between August 2003 andFebruary 2005. And, 133 patients (67 male, 66 female; EVLTonly group) were treated only with endovenouslaser obliteration of all varicosities between March 2005 and July 2006.All patients had saphenofemoral junction reflux. Saphenopopliteal junction reflux existed in 30 patient (22.7%)of combination group, 32 patients (24.1%) of EVLTonly group (p=NS), and perforlating vein reflux was shownin 65 patients of combination group (49.2%), 121 patients (91.0%) of EVLTonly group (p<0.05).Results: There were no significant differences in postoperative complications between the two groups (Table).During the follow-up period (3.2±5.8 months; range, 8 days~32.3 months), reoperation for remaining truncalvaricosities was performed 12 patients (9.1%) in combination group, 11 (8.3%) in EVLTonly group (p=NS).Conclusions: EVLT for the management of combined saphenous and truncal varicose vein is considered to beeffective and safe treatment approach. However, longer follow-up study should be performed.Postoperative complications Postoperative complications Combination group EVLTonly group Ecchymosis (No.) 112 (84.8%) 116 (87.2%) p=NS Pain/paresthesia (No.) 33 (25.0%) 28 (21.1%) p=NS Skin burn (No.) 2 (1.5%) 5 (3.8%) p=NS Edema (No.) 11 (8.3%) 6 (4.5%) p=NS Hyperpigmentation (No.) 5 (3.8%) 4 (3.0%) p=NS Phlebitis (No.) 2 (1.5%) 3 (2.3%) p=NS
  6. 6. Endovenous Laser Therapy (EVLT) and Radiofrequency Ablation (RFA) Of theGreat Saphenous Vein: Analysis Of Early Efficacy and Complications 1:J Endovasc Ther. 2005 Dec;12(6):731-8.Abstract 26alessandra puggioni, MD, michele carmo, MD, manju kalra, mbbs, geza mozes, md, peter gloviczki, md.Mayo Clinic, Rochester, MN, USA.BACKGROUND:EVLT and RFA are new minimally invasive percutaneous endovenous techniques for ablation of theincompetent great saphenous vein (GSV). To evaluate early results, we reviewed saphenous closure rates andcomplications of both procedures.METHODS:Between June 1st 2001 and June 25th 2004, endovenous GSV ablation was performed on 130 limbs in 92patients: EVLT in 77, and RFA in 53; 124 limbs were C2-C4, and 6 were C5-C6. Concomitant proceduresincluded avulsion phlebectomy in 126 limbs, SEPS in 10, small saphenous ablation in 4 (EVLT in 1, ligation in 1,stripping in 2). Early duplex follow-up was obtained in 65 limbs within 1 month from surgery at a median of 7days.RESULTS:Occlusion of the GSV was confirmed in 93.9% of limbs studied (94.4 % in the EVLT 51/54, and 90.9% in theVNUS group 10/11, p=0.53). The distance between GSV thrombus and the common femoral vein (CFV) rangedfrom -20 mm (extension into the CFV) to 50 mm, median 9.5 mm, and was similar between the two groups(median 9 mm vs. 10 mm, p=0.22). Thrombus extended into the lumen of the CFV in 3 limbs after EVLT (2.3%),but not in the RFA group (p=0.27). All 3 patients were treated with anticoagulation; one required a temporaryIVC filter because of a floating thrombus in the CFV. Duplex follow-up of these 3 patients performed at 12, 14and 95 days respectively showed complete resolution of the thrombi. No cases of pulmonary embolismoccurred.. There was a trend towards more proximal extension of GSV thrombus in older patients (p=0.076).Overall complication rate was 15.4% (20.8 % in the EVLT and 7.6 % in the VNUS group, p=0.0487) and includedurinary retention in 1, superficial thrombophlebitis in 4, excessive pain in 6 (3 in the RFA group), hematoma in1, edema in 3 (one in the RFA group), cellulitis in 2. Except for 2 of the 3 patients with thrombus extension intothe CFV, none of these adverse effects required hospitalization.CONCLUSIONS:GSV occlusion after endovenous ablation is achieved in over 90% of cases after both EVLT and RFA at onemonth. In our series 3 cases of thrombus extension into the CFV were observed after EVLT. These findingswarrant early duplex scanning in all patients after endovenous procedures. Long-term follow-up withcomparison to standard GSV stripping is required to confirm the durability of these endovenous procedures.
  7. 7. Endovenous Laser Ablation of the Greater Saphenous Vein in a MajorAcademic Medical Center: Efficacy and Thrombotic MorbidityBrian S. Knipp, MD, Eric J. Ferguson, MD, Jess Bloom, RVT, Elaine Fellows, NP, Susan Blackburn, Amber Clay,RVT, Paul Zajkowski, RVT, Peter K. Henke, MD, David A. Williams, MD, Thomas W. Wakefield, MD.University of Michigan, Ann Arbor, MI, USA.Objective: Examine results of endovenous laser ablation therapy (EVLT) at a major academic center.Methods: EVLT was attempted in 143 limbs, alone (42.0%) or with phlebectomy (58.0%). Clinical assessment:C0[1.4%], C1[2.1%], C2[66.4%], C3[5.6%], C4[14.7%], C5[5.6%], C6[4.2%]; symptomatic[95.1%]. Reflux waspresent in 98.6%; obstruction in 5.6%. Reflux involved the GSV, CFV, and PV in 97.2%, 58.7%, and 23.8%.Results: Successful performance of EVLT led to complete saphenous ablation in 99.3%(n=123) at 1 week and97.1%(n=35) at 1 year. Revised VCSS declined significantly (Table). There were six DVTs (4.3%), one PE (0.7%),six cases (4.3%) of thrombophlebitis, two fluid collections related to phlebectomy, one case of cellulitis, andone of perivenous inflammation. One patient developed a late failure requiring saphenous vein ligation andstripping. There were no differences in DVT or DVT/thrombophlebitis rates for EVLT alone or withphlebectomy (5.1% and 8.5% versus 3.8% and 8.9%, respectively). There were five technical failures (3.5%)due to inability to cannulate the saphenous vein. Absence of reflux in the GSV (OR 129.8, CI=8.1-2085.4,P=.001) and obstructive pathophysiology (OR 43.3, CI=3.4-546.2, P=.004) were predictive of immediatetechnical failure.Conclusion: EVLT produces successful ablation and significant decreases in VCSS. Risk of thromboticcomplications was not associated with phlebectomy, athough the rate of DVT/thrombophlebitis suggests needfor thromboprophylaxis. Immediate technical failure was associated with absence of reflux in the GSV andobstructive pathophysiology. Decrease in Revised VCSS with Time Time Revised VCSS/b> P-Value Preop 4.91 +/- 3.31 0 to 30 d 3.97 +/- 2.37 P = .005 30 to 90 d 2.39 +/- 2.58 P = .001 90 to 180 d 1.91 +/- 1.57 P = .001 180 to 360 d 1.41 +/- 1.86 P = .004
  8. 8. Initial Experience in Endovenous Laser Ablation (EVLA) of Varicose Veins Dueto Small Saphenous Vein RefluxN.S. Theivacumara, R.J. Bealea, A.I.D. Mavora and M.J. Gough , a,aLeeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds, LS1 3EX, UKAccepted 29 October 2006. Available online 16 January 2007.ObjectiveConventional surgery for varicose veins due to small saphenous reflux is associated with high recurrence rates(up to 50%), many resulting from inadequate surgery. This prospective audit examines the safety and efficacyof EVLA in the treatment of this.Method65 patients (68 limbs) with varicosities due to primary or recurrent sapheno-popliteal junction (SPJ) and smallsaphenous vein (SSV) reflux underwent out-patient EVLA (810 nm diode laser). The SSV was ablated from mid-calf to the SPJ. Symptomatic improvement (Aberdeen Varicose Vein Severity Score [AVVSS]), time to return tonormal activity, post-EVLA analgesic requirements, and complications were recorded.ResultsDuplex ultrasound follow-up (median 6-months) confirmed abolition of SPJ/SSV reflux in all limbs following amedian total laser energy delivery of 1131J (IQR 928-1364) at an energy density of 66.3 Joules/cm (IQR 54.2–71.6). AVVSS improved from 15.4 (IQR 11.8–19.7) to 4.6 (IQR 3.2–6.7) at three months (p < 0.001). Mediananalgesia requirement was 3 days (23% [15/65] patients required none) and the median time to normalactivity was 0 (0–4) days (65% [42/65] returning to normal daily activity immediately). There were noinstances of skin burns or DVT but 3 patients (4.4%) developed transient cutaneous numbness (sural nerve).98% (64/65) patients would undergo EVLT again.ConclusionsEVLA abolished SPJ/SSV reflux in all limbs. This is likely to be more effective than conventional surgery,although long-term follow up is required. Data from a randomised control trial would be desirable.Keywords: Varicose veins; Small saphenous vein; Endovenous laser treatment
  9. 9. Initial Experience in Endovenous Laser Ablation (EVLA) of Varicose Veins Dueto Small Saphenous Vein RefluxN.S. Theivacumara, R.J. Bealea, A.I.D. Mavora and M.J. Gough , a,aLeeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds, LS1 3EX, UKAccepted 29 October 2006. Available online 16 January 2007.ObjectiveConventional surgery for varicose veins due to small saphenous reflux is associated with high recurrence rates(up to 50%), many resulting from inadequate surgery. This prospective audit examines the safety and efficacyof EVLA in the treatment of this.Method65 patients (68 limbs) with varicosities due to primary or recurrent sapheno-popliteal junction (SPJ) and smallsaphenous vein (SSV) reflux underwent out-patient EVLA (810 nm diode laser). The SSV was ablated from mid-calf to the SPJ. Symptomatic improvement (Aberdeen Varicose Vein Severity Score [AVVSS]), time to return tonormal activity, post-EVLA analgesic requirements, and complications were recorded.ResultsDuplex ultrasound follow-up (median 6-months) confirmed abolition of SPJ/SSV reflux in all limbs following amedian total laser energy delivery of 1131J (IQR 928-1364) at an energy density of 66.3 Joules/cm (IQR 54.2–71.6). AVVSS improved from 15.4 (IQR 11.8–19.7) to 4.6 (IQR 3.2–6.7) at three months (p < 0.001). Mediananalgesia requirement was 3 days (23% [15/65] patients required none) and the median time to normalactivity was 0 (0–4) days (65% [42/65] returning to normal daily activity immediately). There were noinstances of skin burns or DVT but 3 patients (4.4%) developed transient cutaneous numbness (sural nerve).98% (64/65) patients would undergo EVLT again.ConclusionsEVLA abolished SPJ/SSV reflux in all limbs. This is likely to be more effective than conventional surgery,although long-term follow up is required. Data from a randomised control trial would be desirable.Keywords: Varicose veins; Small saphenous vein; Endovenous laser treatment
  10. 10. Factors Influencing the Effectiveness of Endovenous Laser Ablation (EVLA) inthe Treatment of Great Saphenous Vein RefluxN.S. Theivacumara, D. Dellagrammaticasa, R.J. Bealea, A.I.D. Mavora and M.J. Gough , a,aLeeds Vascular Institute, The General Infirmary at Leeds, UKAccepted 14 August 2007. Available online 1 November 2007.ObjectiveEndovenous laser ablation (EVLA) is an alternative to surgery for treating sapheno-femoral and greatsaphenous vein (GSV) reflux. This study assesses factors that might influence its effectiveness.DesignProspective, observational study.MethodEVLA was used to treat the great saphenous vein in 644 limbs as part of the management of varicose veins.Body mass index (BMI), maximum GSV diameter, length of vein treated, total laser energy (TLE) and energydensity (ED: Joules/cm) delivered were recorded prospectively. Data from limbs with ultrasound confirmedGSV occlusion at 3-months were compared with those where the GSV was partially occluded or patent.Complications were recorded prospectively.ResultsGSV occlusion was achieved in 599/644 (93%) limbs (group A). In 45 limbs (group B) the vein was partiallyoccluded (n = 19) or patent (n = 26). Neither BMI [group A: 25.2 (23.0–28.5); group B: 25.1 (24.3–26.2)], norGSV diameter [A: 7.2 mm (5.6–9.2); B: 6.9 mm (5.5–7.7)] influenced success. TLE and ED were greater (p <0.01) in group A (median [inter-quartile range]: 1877 J (997–2350), 48 (37–59) J/cm) compared to group B(1191 J (1032–1406), 37 (30–46) J/cm). Although TLE reflects the greater length of GSV ablated in Group A (33cm v 29 cm, p = 0.06) this does not influence ED. GSV occlusion always occurred when ED ≥ 60 J/cm with noincrease in complications.ConclusionsED (J/cm) of laser delivery is the main determinant of successful GSV ablation following EVLA.Keywords: Varicose veins; Endovenous laser ablation (EVLA); Great saphenous vein; Laser effectiveness;Influencing factors
  11. 11. Endovenous Laser Ablation of the Great Saphenous Vein with a 980-nmDiode Laser in Continuous Mode: Early Treatment Failures and SuccessfulRepeat TreatmentsHyun S. Kim MD , a, and Ben E. Paxton BAaaRussell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School ofMedicine, 600 North Wolfe Street, Blalock 545, Baltimore Maryland 21205Received 15 December 2005; revised 9 April 2006, 13 June 2006; accepted 19 June 2006. Available online 30March 2007.PURPOSETo investigate the efficacy of lower-energy endovenous laser treatment for great saphenous vein (GSV)incompetence and treatment parameters associated with early treatment failure.MATERIALS AND METHODSSixty consecutive endovenous laser treatments (32 left, 28 right; 57 initial treatments, three repeattreatments) in 48 patients (13 men, 35 women; mean age, 55.2 ± 12.9 years), with bilateral treatments in ninepatients, were studied. Preprocedural clinical signs, etiology, anatomy, and physiologic classificationsdemonstrated class 2 limbs in 11.7% of cases, class 3 limbs in 25.0%, class 4 limbs in 48.3%, and class 5 limbs in15.0%. All initial and repeat treatments were performed with lower-energy with use of a 980-nm diodeendovenous laser at 11 W in continuous mode. Patients wore class II compression stockings for 2 weeks andwere followed up at 1, 3, and 6 months with clinical and duplex ultrasound examinations. Treatment failureswere diagnosed at 3 months on the basis of GSV patency or lack of clinical improvement. Diameter and lengthof GSV treated, treatment energy parameters, and clinical outcomes were prospectively measured andcompared between successful and failed treatments.RESULTSThe initial treatment success rate was 94.7% (54 of 57). The mean maximum diameter of successfully treatedGSVs was 1.12 ± 0.52 cm, and the mean maximum diameter of GSVs in which treatment failure occurred was2.05 ± 0.23 cm (P = .008). Mean total energy applied for successful treatments was 1,131.3 ± 248.1 J, andmean total energy applied for failed treatments was 1,439.6 ± 425.0 J (P = 0.053). Mean unit energy appliedfor successful treatments was 32.7 ± 7.5 J/cm, and that for failed treatments was 32.8 ± 4.9 J/cm (P = .986). Allpatients in whom treatment failed were successfully treated again with a mean total energy of 1,393.0 ± 81.0J and a mean unit energy of 29.4 ± 4.9 J/cm. There were no significant differences in mean total energy or unitenergy applied among successful, failed, and repeat treatments (P > .05). Mean follow-up duration was 6.8months.CONCLUSIONSEndovenous laser treatment with lower energy appears to be safe and effective. Larger GSV diameter isassociated with early treatment failures.

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