Effect of a Nd:YAG Laser in the Treatment of Varices of the Great Saphenous Vein After Polidocanol Microfoam Injection

Javier Moreno, Mario A. Trelles and Josefina Royo de la Torre.

Instituto Médico Láser, Madrid, SPAIN
Instituto Médico Vilafortuny, Cambrils, SPAIN

Increased efficacy of vein closure when injecting polidocanol microfoam followed by Nd:YAG laser emission in the treatment of (class I to III) leg varices has been observed. We present the evaluation of this procedure treating varices greater than 5 mm in diameter and, specifically referring to varicose dilations of the axis of the great saphenous vein.

Forty patients were selected suffering from chronic venous insufficiency due to an incompetent axis of the great saphenous vein. Diagnosis was done using an eco-doppler (Sonolite by Siemens). In all patients, measurements were taken in supine position, the affected limb raised to an angle of 30º.

The diameter of the saphenous vein was measured at the sapheno-femoral union and the diameter of the axis of the great saphenous vein at a distance of 30 cm from the inguinal fold. At these two points, we also assessed the distance between the skin surface and the upper limit of the axis of the saphenous vein. Vessel calibre was determined once more following injection of polidocanol microfoam, and again after having been subjected to Nd:YAG laser pulses. A good result was scored when there was an absence of reflux in the saphenous axis at 30 and 90 days after the procedure. Results analysis was based on Pearson's linear correlation coefficient ("r").

For the forty patients treated, an absenceis noticed of reflux in the axis of the great saphenous at the 30 and 90 day follow-up points. After injecting polidocanol in the form of a microfoam, a drastic reduction was observed in the saphenous calibre to one third of its initial value, which presented a significant reduction after being subjected to the combined treatment.

The mean distance between skin and the saphenous inguinal vein at the level of the junction was of 12.66 mm, and at 30 cm from the fold of 6.66 mm. The pre-treatment calibre of the saphenous vein at the junction/arch was 7.17 mm and on the axis 30 cm from the inguinal fold of 6.44 mm. Following the injection of polidocanol foam, the calibre was reduced to 4.71 mm at the junction and to 3.49 on the axis. Following Nd-YAG laser pulses, the calibre at the junction was 3.28 mm and at the axis of 2.68 mm.

The usefulness of polidocanol foam in the treatment of the major varicose axes has been reported by several authors. The biggest setbacks are due to hyperpigmentation caused by hemosiderine with regard to the coagulated blood inside the vessel. Nd:YAG laser, by attaining an additional reduction of the calibre, minimises this setback. The method presented contributes greater safety of results and lessens inconveniences of this non-invasive procedure in the treatment of severe varices.