Factors Affecting Residual Stump Length Following Endovenous Laser Ablation

Area of Science:

• Vascular Surgery
• Minimally Invasive Procedures
• Venous Thromboembolism Prevention

Background:

• Current endovenous laser ablation (EVLA) guidelines recommend laser fiber tip placement at least 2 cm from the saphenofemoral or saphenopopliteal junction.
• This aims to minimize deep vein thrombosis (DVT) risk while ensuring Great Saphenous Vein (GSV) or Short Saphenous Vein (SSV) occlusion near the junction to prevent recurrence.

Purpose of the Study:

• To assess the impact of pre-operative laser fiber tip distance from the junction on residual stump length after EVLA.
• To identify other factors influencing residual stump length and DVT risk.

Main Methods:

• Retrospective analysis of an electronic database of patients undergoing EVLA for GSV and SSV under local anesthesia.
• Exclusion of patients with prior venous thromboembolic events or incomplete data.
• Venous Duplex scans at 6 weeks post-procedure to evaluate residual stump and DVT; multivariable logistic regression for confounder analysis.

Main Results:

• Analysis of 825 patients (35.2% of 2341) with complete data from 2012-2018.
• Flush occlusion occurred in 8.4% of patients; 0.4% had non-DVT femoral/popliteal vein extension; 1 patient had DVT.
• Increased pre-operative junction distance and higher BMI were associated with lower flush occlusion rates. Short saphenous vein (SSV) EVLA showed higher flush occlusion rates (OR 4.11).

Conclusions:

• Consideration should be given to increasing intra-procedure laser tip distance beyond 2 cm, particularly for SSV treatments, to ensure adequate stump length and reduce DVT risk.
• Lower BMI may be associated with a higher risk of stump complications, though the reasons require further investigation.