Endovenous Laser Ablation (EVLA) Below the Knee with and without Chemical Ablation below Knee in Great Saphenous Vein Varicosity

Background: For many years, varicose veins have been one of the most frequently treated venous issues. In the treatment of superficial venous insufficiency, endovenous laser ablation (EVLA) and concurrent ultrasound-guided foam sclerotherapy have recently emerged as viable alternatives to surgery.
Aim: This study aimed to compare between outcome of EVLA below the knee with and without foam sclerotherapy in great saphenous vein (GSV) varicosity.
Patients and methods: This study involved 160 patients presented by primary GSV varicosities of the lower limb (LL). Patients were split evenly between two groups; Patients in group (A) received EVLA only below the knee. However, Patients in group (B) had combined full EVLA and sclerotherapy (chemical ablation) below the knee. In the present investigation, the Venous Clinical Severity Score (VCSS) and Visual Analogue Scales (VAS) were used both before and after the therapy.  
Results: After one week of interventions, combined EVLA and chemical ablation group has a higher occlusion rate (100%) compared to (97.5%) for EVLA only group where complete occlusion was more prominent than partial occlusion, however, two patients (2.5%)  have a recanalization in EVLA only group with significant difference between both groups regarding complete and partial occlusion (p=0.015 and 0.038). Also, after six months of interventions, percent of complete occlusion increased with one patient has a recanalization in EVLA only group with significant difference between both groups regarding complete and partial occlusion (p < 0.001 and 0.028). Conclusion: Combining EVLA and sclerotherapy (chemical ablation) for below-the-knee long saphenous varicosities offers a very successful method to extend the treatment down to the foot, decrease the prevalence of saphenous nerve injury, and reduce the number of treatment session and recurrence.