Endovenous laser ablation of insufficient perforating veins: Energy is key to success

Objective: To evaluate the feasibility and anatomical success of endovenous laser ablation (EVLA) of incompetent perforating veins (IPV). Methods: All 135 consecutive patients with IPV treated with ELVA (intention-to-treat) from January 2008 to December 2013 were included. Up to the end of 2011, an 810-nm laserset (14 W) was used, and afterwards, a 1470-nm laserset (6 W) was introduced. Duplex ultrasound was performed at 6 weeks’ follow-up to assess anatomical success. Results: Overall anatomical success at 6 weeks’ follow-up was 56%. Anatomical success was 63% after treatment with 810 nm and 45% with 1470 nm (p = 0.035). This difference in the success rate seems associated with the significantly higher amount of energy delivered in the 810 nm cohort (560 J) versus 1470 nm (186 J). Regardless of the type of laser, anatomical success was significantly higher after treatment with more than 400 J (66%) compared with 0–200 J (40%, p = 0.009) and 200–400 J (43%, p = 0.029). Complications were limited to two cases of transient paresthesia. Conclusions: EVLA of IPVs is safe and feasible. The amount of energy is highly important in achieving anatomical success.