Abstract
OBJECTIVE: This study evaluates hemodynamic and anatomic changes in great saphenous vein (GSV) tributaries after endovenous laser ablation (EVLA). METHODS: This case series analyzed 112 areas in 28 lower limbs of 25 patients who underwent EVLA from April 2022 to June 2023 at the Hospital das Clínicas de Pernambuco/UFPE. All patients were evaluated by Doppler ultrasound preoperatively and 3 months after the surgical treatment. The parameters studied were GSV diameter and patency, GSV tributary diameter, patency and flow direction, and the Venous Clinical Severity Score after EVLA. The GSV characteristics were evaluated in four regions: saphenous-femoral junction, medium thigh, knee, and medium leg. The tributary veins were grouped in four areas: anterior thigh, posterior thigh, anterior leg, and posterior leg. RESULTS: The results included 28 lower limbs from 23 patients; 18 patients (67.9%) were women, and the average age was 49 years; 2 patients were lost to follow-up. Ninety days after EVLA, all treated GSVs were occluded. The average diameter of GSV decreased in all four regions studied: saphenous-femoral junction, medium thigh, knee, and medium leg (P ≤ .001). We analyzed 101 GSV tributaries. In the analysis of GSV tributaries by area, we identified a mean diameter decrease in all groups of tributaries (P < .001). Considering the tributaries with reflux, we also identified a reduction in the number of tributaries with reflux in all four groups (P ≤ .001). All tributaries were patent preoperatively; at 3 months after the surgical treatment, GSV tributaries occlusion was infrequent, except for the anterior thigh group. There was a decrease from 9 to 5 points in Venous Clinical Severity Score after EVLA (P < .001). CONCLUSIONS: This study demonstrated that, after GSV laser ablation, there was a statistically significant decrease in the diameters of all tributary groups, and the number of tributaries with decreased reflux; however, the occlusion of tributaries was not a frequent finding.