Current guidelines recommend ablation of varicose veins after a superficial vein thrombosis to reduce the risk of thrombotic recurrency. Endovenous laser ablation (EVLA) has become the standard treatment of saphenous varicose veins (SVV), however it is unknown if EVLA of postthrombotic SVV is feasible. The aim of our study is to assess the efficacy and safety of EVLA for the treatment of postthrombotic SVV.

we performed a retrospective study using data from the ongoing VEINOVA (Vein Occlusion with Various Techniques) registry. We identified postthrombotic SVV treated by EVLA (= study group) that we compared to SVV without any postthrombotic signs treated by EVLA (= control group). In the study group we assessed the severity of postthrombotic changes according to a novel PostThrombotic Superficial Vein Scoring System (PTSVSS), and compared interventional details (number of cannulation sites, laser energy applied) with the control group. Primary endpoints at 6 weeks follow-up were the total occlusion rate of treated SVV for efficacy, and the incidence of endothermal heat-induced thrombosis (EHIT), deep vein thrombosis (DVT) or pulmonary embolism (PE) for safety.

In a total of 2460 patients included in the registry, 3343 SVV were treated by EVLA, of which 96 (3%) were performed on postthrombotic SVV (= study group). Mean age was higher in the study group (62.6 ± 16y vs. 55.8 ± 14.8y, P<.001), with similar percentage of female patients (67% vs. 70.8%; P=.478). In the study group, postthrombotic changes were mild in 72 (75%), moderate in 7 (7.3%) and severe in 17 (17.7%) of cases according to the PTSVSS. In the study group, laser energy applied was similar (64.5 ± 23.7 J/cm vs 63.4 ± 23.9 J/cm, P=.67) but need for several cannulation sites was higher (8.3% vs 2.2%, P=.002) than in the control group. At 6 weeks follow-up, in the study group total occlusion of the treated SVV was obtained in 100% (vs 99.9% in the control group, P=.808), EHIT occurred in 2.1% (vs 0.9%, P=.232) and DVT in 2.4% (vs 0.62%, P=.10), without any PE in both groups

EVLA for the treatment of postthrombotic SVV seems to be efficient and safe, but potentially technically more difficult requiring more frequently several vein cannulations than for non-postthrombotic SVV.