THE DEVELOPMENT OF INDICATIONS FOR ENDOVENOUS LASER OBLITERATION (EVLO) OF MAJOR SAPHENOUS VEINS IN PRIMARY VARICOSIS

Objective of the study is to develop indications and optimal conditions for endovenous laser obliteration (EVLO) of major saphenous veins in patients with primary varicosis. Materials and methods: the study included 92 patients subjected to medical examination, analysis of superficial vein lesions, and ultrasound duplex scanning. Results and discussion: thirty-four (37.0 %) patients refused to undergo EVLO and withdrew from the study as it entered the clinical phase. The refusal was justified by huge varicose transformation of the tributaries of the great saphenous vein in the lower leg and at the inner thigh surface, dilation of v. saphena accessories lateralis, and trophic lesions that required endoscopic dissection of perforating veins as well as by conditions unrelated to the affection of the superficial venous system. We considered it unadvisable to perform EVLO in another 14 patients (15.2 %) based on the results of ultrasound duplex scanning that revealed incompetence of a small segment of the trunk of the main saphenous vein, the lack of reflux in saphenous trunks, aneurysmal dilation of the great saphenous vein along its length and close to the opening. Conclusion: EVLO is especially efficacious when performed in patients with a clinical variant of primary varicosis characterized by extended trunk reflux involving a shunt down to the lower third of the thigh - the upper third of the lower leg in the great saphenous vein and down to the middle of the lower leg in the small saphenous vein. The best results of EVLO are obtained when the linear venous trunk of less than 10 mm in diameter in the horizontal position is uniformly dilated along its entire length. Varicose dilation of tributaries in the thigh and their marked transformation in the lower leg question practicability of EVLO.