Based on findings presented at the 21st European Venous Forum (EVF) Annual Meeting (24–26 June, online), Imre Bihari (A+B Clinic, Budapest, Hungary) speaks to Venous News about the benefits of laser crossectomy.
What is the laser crossectomy technique used for and how does it works?
Laser crossectomy is used in the case of an insufficient saphenofemoral junction (SFJ). It was proven during the classical varicose vein surgery era that there would be early recurrences if crossectomy was not performed. We had the same experience with laser surgery. When we introduced laser crossectomy, the number of early recurrences dropped. It works in a similar way to classical crossectomy in that tributaries are closed, which prevents recurrence. Our data show that early recurrence after one year was 13.8% without crossectomy, compared to 1.2% with the introduction of the laser crossectomy technique.
Laser crossectomy and surgical crossectomy are two well-described techniques. What are the benefits of a laser versus a surgical approach?
The benefit of laser over surgery is that it causes less scar tissue in the groin and so neovascularisation is very rare. In our material, after five years the rate is 2%, compared to a figure of 68% in surgical crossectomy cases. This was the most common cause of recurrent varicosity after classical surgical varicectomy. In addition, the most frequent complication of classical surgical crossectomy is a wound-healing issue in the groin, which does not occur with laser surgery.
What are your key takeaways from the 12 years’ worth of data from 2,300 cases?
With the introduction of laser crossectomy, we realised that dilated and even very dilated veins can be operated on with laser. In fact, we did not find any cases that were not suitable for laser. We now have over 10 years’ worth of experience with cases that were formerly excluded from laser studies. We have been able to look at how different vein conditions influence recurrence, and also how other factors, such as a patient’s weight, pregnancy, and cardiac decompensation, can influence long-term results.
What are some of the key considerations to ensure that laser crossectomy is successful?
It seems that a higher dose of tumescent is necessary to better compress the SFJ, as well as to entrap heat in the great saphenous vein (GSV) and hinder its flow into the femoral vein (10ml/cm). In addition, more energy delivery (about 200J/cm) is recommended for a firm closure of this part of the GSV. To prevent venous thromboembolism (VTE), we use low molecular weight heparin (LMWH). And finally, the tip of the laser fibre must be closer to the femoral vein than was previously recommended. Nowadays, we place it 0.5cm from the femoral vein.