Introducing Endovenous Laser Therapy Ablation to a National Health Service Vascular Surgical Unit: The Aberdeen Experience

Objectives
To report early clinical outcomes and learning experience following the introduction of endovenous laser ablation (EVLA) to an NHS vascular unit.

Design
Prospective observational study.

Results
Between February 2006 and January 2008, 631 consecutive patients underwent EVLA to 704 refluxing truncal veins – 579 GSV, 119 SSV and 6 straight segments of anterior accessory GSV. 275/631 (44%) patients had local anaesthesia (LA) plus sedation, 237 (38%) had LA only and 119 (18%) had general anaesthesia. All were treated using the 810 nm diode laser. Adjuvant procedures on-table included foam sclerotherapy 129/704 (18%), multiple stab avulsions 53/704 (8%) and 3 limbs had both. Three-month follow-up with duplex examination is complete in 635/704 limbs (90%). Complete occlusion was noted in 610 veins (96%), 14 (2.2%) were partially occluded and 11 (1.7%) showed no occlusion. 193 (30%) of the 635 limbs seen at follow-up required further treatment for residual varicosities using foam sclerotherapy. There has been one non-fatal pulmonary embolus associated with EVLA and no other complications.

Conclusions
EVLA is safe and technically effective. It has a defined learning curve requiring new operator skills which can be readily acquired.