Damage to subcutaneous nerves in endovenous laser coagulation of the great saphenous vein

Fokin A.A.¹, Borsuk D.A.², Vasiliev I.S.³, Shaldina M.V.¹

1) Department of Surgery, Institute of Additional Professional Education, South Ural State Medical University of the RF Ministry of Public Health,
2) Clinic of Phlebology and Laser Surgery,
3) Department of Plastic Surgery and Cosmetology, South Ural State Medical University, Chelyabinsk, Russia

The purpose of this study was to assess the incidence of the development of symptoms of damage to subcutaneous nerves after endovenous laser coagulation (EVLC) of the great saphenous vein (GSV), as well as to determine the effect of these symptoms on quality of life (QoL) of patients.

Our retrospective study enrolled a total of 119 patients (mean age 50±13.9 years) subjected to 151 isolated EVLC of the GSV. The average volume of the injected anaesthetic per 1 cm of the vein’s length amounted to 8.5±1.9 ml. Puncture of the GSV at the level of the thigh was performed in 37 (24.5%) cases, at the level of the crus in 114 (75.5%) cases. The intervention was performed at the power 5-10 W and linear density of energy approximately 70 J/cm. The median of the follow up period amounted to 264 days. The patients were interrogated by phone. The questionnaire included leading, understandable for patients questions about the presence of postoperative complaints characteristic of damage to subcutaneous nerves, as well as the question about the effect of these complaints on quality of life.

The complaints characteristic of damage to subcutaneous nerves were reported for 61 (40.4%) operated limbs, with these symptoms decreasing quality of life only in 7 (4.6%) cases. All respondents noted gradual regression of the symptoms with time. The median of symptom relief amounted to 2 months. The analysis of interrelationship between the level of puncture by the thirds of the femur and crus and the damage of subcutaneous nerves demonstrated no statistically significant association (p=0.108), unlike the analysis by the femur/crus level, wherein the infragenicular puncture significantly increased the risk of traumatisation of subcutaneous nerves (p=0.022). No statistically significant differences by the frequency of damage to subcutaneous nerves depending on the power of energy were revealed (p=0.662).

The obtained findings make it possible to recommend EVLC, including with puncture of the GSV below the knee, for patients with varicose veins in this basin.

KEY WORDS: varicose veins, endovenous laser coagulation, damage to subcutaneous nerves, quality of life.

P. 88

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