Endovenous laser treatment of incompetent below-knee great saphenous veins

PURPOSE: To test the hypotheses that below-knee great saphenous vein (GSV) reflux after successful ablation of the incompetent above-knee GSV is a cause of incomplete clinical success and that endovenous laser treatment (ELT) of the incompetent below-knee GSV can safely eliminate persistent symptoms. MATERIALS AND METHODS: The author evaluated 576 consecutive ELT procedures of the GSV. Fifty ELT procedures in incompetent calf GSVs were included in this study. Patients with reflux of the entire GSV were selected. All patients underwent clinical and ultrasonographic (US) follow-up. RESULTS: In 16 of the 50 procedures, ELT was performed in the GSV both above and below the knee in separate sessions. In 34 procedures, ELT of the GSV above and below the knee was performed at the same session. An 810-nm laser was used at 14 W. The mean energy was 82 j/cm (range, 56.4-114 j/cm; standard deviation [SD], 14 j/cm). The mean follow-up was 11 months (range, 0-28 months; SD, 7 months). Four paresthesias occurred. Medial ankle pain resolved in all patients, and swelling resolved in all but six limbs. No recanalization occurred. CONCLUSIONS: Patients with incompetence of the entire GSV treated with only ELT of the above-knee GSV experienced incomplete relief of medial ankle pain and swelling; however, symptomatic relief is obtained safely and effectively with additional ELT of the below-knee GSV.