International Journal of Scientific and Research Publications Submission                                                                

ISSN: pending

Retrospective Analysis: Collateral nerve damage and local tissue trauma associated with endovenous laser ablation therapy

Joseph Gracéϯ, Ya Wangϭ, David Robinsonϯ, Carlos Tahuil , Rena Xuϯ

ϯ Interventional Vascular Lab, North Shore Medical Group Sydney NSW Australia

ϭ Department of Vascular Surgery, Nanyang Central Hospital Henan Province Central China

Speaker- Joseph Gracé.

Presentation Type- Original research, retrospective analysis.

Abstract-

Purpose:

Interventional procedures and in particular, endovenous laser ablation (EVA) used in the treatment of venous disorders have increased significantly over the past decade1. Although this has also resulted in a reduction in patient morbidity and mortality, the incidence of nerve damage associated with these procedures remains important2. Saphenous nerve injury and sural nerve injury have been recognised as a material risks associated with surgical stripping and phlebectomy3. The purpose of this study was to identify the incidence of nerve injury associated with endovenous laser ablative  procedures.

Methods

A retrospective analysis was performed on the all treated patients managed by the authors in their respective facilities. Patient consent was given by all participants in this study.

Patients were grouped according to the saphenous vein segment that was treated and labelled as; great saphenous vein above knee (GSV-AK), great saphenous vein below knee (GSV-BK), and small saphenous vein (SSV). Nerve injury was categorised as; paresthesia or dysaesthesia, numbness to light touch, and complete loss of nociception. The onset and duration of symptoms was also classed as; temporary (0-14 days post procedure), prolonged (2-12 weeks) and permanent (greater than 12 weeks).

All procedures were performed under direct ultrasound guidance and saphenous sheath tumescent anaesthesia was used in all cases and ranged from 200 to 500 ml in volume per treatment session. The laser generator used was the BIOLITEC CERALAS D15 980nm Laser-Diode and either the 600 micrometre or 400 micrometre laser fibre was used to ablate the diseased segment. The findings were reported on the patient’s electronic health record at the time of routine follow up at 2 weeks, 3 months and 12 months after the procedure.

Results

A total of 2,497 laser treated segments were analysed and included in this study.

There were a total 23 cases of  nerve deficits identified and were included in the temporary (0-14 days post procedure) group. Within this group there were; 14 reports of paraesthesia and dysaesthesia, 7 reports of numbness to light touch, and 2 reports of complete loss of nociception. 19 cases were associated with the symptoms located over the middle third of the below knee segment and within the distribution of the saphenous nerve. 4 cases were associated with the lateral aspect of the lower limb and proximal to the lateral malleolus within the distribution of the sural nerve. Symptoms were confined to a patch of skin no greater than 40 square centimetres in all cases.

There were 4 cases that persisted and were included in the prolonged (2-12 weeks) group. Within this group, 3 reports were dysaesthesia and 1 was complete loss of nociception.

There was 1 case of dysaesthesia that persisted for 9 months, however this resolved spontaneously.

Segment

Case Reports

temporary

% of total case reports

prolonged

% of total case reports

permanent

% of total case reports

GSV Above knee

1198

0

0.00%

0

0.00%

0

0.00%

GSV below knee

521

19

3.65%

3

0.58%

1

0.19%

SSV

778

4

0.51%

1

0.13%

0

0.00%

Total

2497

23

0.92%

4

0.16%

1

0.04%

Conclusion

The authors have completed a retrospective analysis of 2497 cases treated over the past decade and have reported the incidence and severity of nerve damage associated with endovenous laser ablation.

The overall incidence of temporary nerve deficit was less than 1 percent and this is low indeed. It needs to be borne in mind that in all cases, ultrasound guided tumescent anaesthesia was used. The physical volume effect of the tumescent fluid injected was an important contributor to the physical displacement of the adjacent sensory nerves and in addition was acting as a heat sink buffering the sensory nerve from thermal injury.

The authors conclude that EVA with the concomitant use of tumescent anaesthesia in the treatment of saphenous trunks to be associated with a very low incidence of prolonged or permanent nerve defecit.

Index Terms- Endovenous laser ablation, therapy, complications, EVA, EVLT, EVLA

Authors

First Author – Joseph Gracé, MBBS(HONS)FACP, Phlebologist & Vascular Interventionalist, North Shore Medical Group Sydney, Australia. drgrace@gmedical.com.au 

Second Author – Ya Wang, Chief Vascular Surgeon & Chief of Department, Nanyang Central Hospital Henan Province, Central China. 2035868399@qq.com 

Third Author – David Robinson, Vascular Surgeon, North Shore Medical Group Sydney, Australia. drrobinson@gmedical.com.au

Fourth Author – Carlos Tahuil Ochoa, Phlebology Registrar & Research Fellow, North Shore Medical Group Sydney, Australia. drcto@gmedical.com.au

Fifth Author – Rena Xu, Chief Vascular Sonographer, North Shore Medical Group Sydney, Australia. rena@gmedical.com.au

Correspondence Author – Dr Joseph Grace – drgrace@gmedical.com.au +61 404 555 855

References:

1- Khilnani M, De La Torre J. Varicose Vein Treatment With Endovenous Laser Therapy. Medscape (updated) 2016 Jan 15. Available from: https://emedicine.medscape.com/article/1815850-overview#a1

2- Yilmaz S, Delikan O, Aksoy E. Saphenous nerve injury after endovenous laser ablation of incompetent greater saphenous vein: An electroneuromyography study. Phlebology. 2016 Mar; 31(2): 106-110.  doi: 10.1177/0268355514568533. Epub 2015 Jan 12.

3- Sam R. C, Silverman S. H, Bradbury A.W. Nerve Injuries and Varicose Veins Surgery. Eur J Vasc Endovasc Surg 27, 113–120 (2004). doi: 10.1016/j.ejvs.2003.11.007, Available online at https://pdfs.semanticscholar.org/85b2/e6dc922c8a1099633a3abd250d1aefa1f886.pdf

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