Avaliação da termoablação com endolaser da veia safena parva com anestesia local
Evaluation of endolaser thermoablation of the small saphenous vein under local anesthesia
Filipe Cézar Bertassoni de Souza; Walter Jr. Boim de Araujo; Adriana Buechner de Freitas Brandao; Camila de Almeida Mazzoni; Fabiano Luiz Erzinger; Filipe Carlos Caron; Viviane Gomes Milgioransa Ruggeri
Background: The small saphenous vein (SSV) is affected in 15% of chronic venous insufficiency (CVI) cases. Conventional surgery is the standard technique for treatment of SSV insufficiency, but sural nerve injury is a complication of great concern. Endovenous laser ablation is a surgical technique for treatment of CVI that is considered likely to reduce morbidity and mortality. Objectives: To evaluate patients with CVI undergoing endovenous laser ablation of the SSV at least 30 days after the procedure. Methods: We analyzed 54 lower extremities in 46 patients scheduled for 1470-nm endovenous laser ablation under local anesthesia to treat CVI in a tertiary hospital. Patients were evaluated preoperatively, intraoperatively, and postoperatively over 30 days with clinical examination, physical examination, and ultrasound. Results: In the 54 lower extremities treated, there was a significant difference (p < 0.003) in terms of reduction in the diameter of treated veins (6.37 mm preoperatively and 5.15 mm on the 30th postoperative day) and improvement in the venous clinical severity score (VCSS) (means of 8.02 preoperative and 6.11 on the 30th postoperative day) (95%CI, 5.01—7.21) (p < 0.02). Postoperative complications such as paresthesia and phlebitis were present and diagnosed in 5 and 3 patients, respectively, but did not affect their quality of life or routine activities. Conclusions: Intravenous laser ablation of the SSV proved to be safe and effective for reducing clinical symptoms and improving quality of life.
1 Sociedade Brasileira de Angiologia e de Cirurgia Vascular. Varizes dos membros inferiores: tratamento cirúrgico [Internet]. São Paulo: AMB; 2012 [citado 2020 fev 18]. p. 1-10. Disponível em:
2 Brito CJ, Silva RM. Cirurgia vascular: cirurgia endovascular, angiologia. 4. ed. Rio de Janeiro: Revinter; 2019.
3 Kaplan RM, Criqui MH, Denenberg JO, Bergan J, Fronek A. Quality of life in patients with chronic venous disease: San Diego population study. J Vasc Surg. 2003;37(5):1047-53.
4 Maffei FH, Yoshida WB, Rollo HA. Doenças vasculares periféricas. 5. ed. Rio de Janeiro: Guanabara; 2015.
5 Tellings SS, Ceulen RP, Sommer A. Surgery and endovenous techniques for the treatment of small saphenous varicose veins: a review of the literature. Phlebology. 2011;26(5):179-84.
6 Rossi GG, Belczak CE, Rossi C. Veia safena parva: para onde se dirige o refluxo? J Vasc Bras. 2013;12(2):123-8.
7 Burihan E. Estudo anatômico da veia safena parva [tese]. São Paulo: Escola Paulista de Medicina; 1972.
8 Romualdo AP, Bastos RM, Fatio M, et al. Extensão cranial da veia safena parva: quando o fluxo caudal é normal. J Vasc Bras. 2009;8(2):166-70.
9 Memetoglu ME, Kurtcan S, Kalkan A, Özel D. Combination technique of tumescent anesthesia during endovenous laser therapy of saphenous vein insufficiency. Interact Cardiovasc Thorac Surg. 2010;11(6):774-7.
10 Nwaejike N, Srodon PD, Kyriakides C. Endovenous laser ablation for short saphenous vein incompetence. Ann Vasc Surg. 2009;23(1):39-42.
11 Theivacumar NS, Beale RJ, Mavor AI, Gough MJ. Initial experience in endovenous laser ablation (EVLA) of varicose veins due to small saphenous vein reflux. Eur J Vasc Endovasc Surg. 2007;33(5):614-8.
12 Elias S, Khilnani N. Treating the Small Saphenous Vein – Anatomical considerations and techniques for treating the SSV and junctional tributaries [Internet]. Endovascular Today. 2008 [citado 2019 dez 16]. p. 60-4. Disponível em:
13 Heger M, van Golen RF, Broekgaarden M, et al. Endovascular laser–tissue interactions and biological responses in relation to endovenous laser therapy. Lasers Med Sci. 2014;29(2):405-22.
14 Desmyttère J, Grard C, Stalnikiewicz G, Wassmer B, Mordon S. Endovenous laser ablation (980 nm) of the small saphenous vein in a series of 147 limbs with a 3-year follow-up. Eur J Vasc Endovasc Surg. 2010;39(1):99-103.
15 Huisman LC, Bruins RM, van den Berg M, Hissink RJ. Endovenous laser ablation of the small saphenous vein: prospective analysis of 150 patients, a cohort study. Eur J Vasc Endovasc Surg. 2009;38(2):199-202.
16 Janne d’Othée B, Walker TG, Kalva SP, Ganguli S, Davison B. Endovenous laser ablation of the small saphenous vein sparing the saphenopopliteal junction. Cardiovasc Intervent Radiol. 2010;33(4):766-71.
17 Boersma D, Kornmann VN, van Eekeren RR, et al. Treatment modalities for small saphenous vein insufficiency: systematic review and meta-analysis. J Endovasc Ther. 2016;23(1):199-211.
18 Gibson KD, Ferris BL, Pepper D. Foam sclerotherapy for the treatment of superficial venous insufficiency. Surg Clin North Am. 2007;87(5):1285-95, xii-xiii.
19 Wittens C, Davies AH, Baekgaard N, et al. Editor’s choice – management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678-737.
20 Samuel N, Carradice D, Wallace T, Mekako A, Hatfield J, Chetter I. Randomized clinical trial of endovenous laser ablation versus conventional surgery for small saphenous varicose veins. Ann Surg. 2013;257(3):419-26.