Possibilities of endovenous laser obliteration of subcutaneous veins with tumescence by cold saline solution

Fokin A.A.¹, Borsuk D.A.², Zhdanov K.O.²

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, Chelyabinsk, Russia

Objective. The purpose of the present study was to assess the possibility of carrying out endovenous laser obliteration (EVLO) with radial light guides on a laser device operating at a wavelength of 1470 nm, using for tumescence only cold normal saline solution without additional sedation or narcosis in patients with allergy to local anaesthetics.

Patients and methods. Our prospective non-comparative single-centre study consecutively included 37 patients who from November 2014 to June 2019 underwent a total of 41 isolated EVLO procedures without simultaneous miniphlebectomy or sclerotherapy of tributaries. Given the previous history of allergy to amide-group local anaesthetics and/or multiple allergic reactions to other agents, these patients received as anaesthesia and tumescence exclusively normal saline solution cooled to a temperature of + 3-6°C, without addition of local anaesthetics or any other therapeutic agents, with neither sedation nor narcosis.

Results. The great saphenous vein was subjected to coagulation in 33 (80.5%) cases, the anterior accessory saphenous vein in 5 (12.2%), and the small saphenous vein in 3 (7.3%) cases. The median of the mean diameter of the veins at 3 cm from the saphenofemoral or saphenopopliteal junction amounted to 10 mm (1^st quartile 8.2; 3^rd quartile 11). The median of the mean length of the coagulated vein – 45 cm (1^st quartile 22; 3^rd quartile 51), the median of the average amount of the administered normal saline solution – 300 ml (1^st quartile 200; 3^rd quartile 450), the median of the average amount of normal saline per 1 centimetre of the venous length – 8.7 ml (1^st quartile 7.5; 3^rd quartile 10). All patients without exception tolerated the intervention. The process of laser obliteration was not discontinued due to pronounced perioperative pain syndrome in any case. All patients after the procedure answered the question «Would you repeat a similar intervention if the need arises?» in the affirmative. All the 41 (100%) veins subjected to coagulation were obliterated at early terms of follow up, with no ultrasonographic evidence of recanalization.

Conclusions. The obtained findings suggest a possibility of performing EVLO in patients with an allergy-burdened history in relation to local anaesthetics using for tumescence exclusively normal saline solution chilled to a temperature of + 3-6°C, with no additional sedation or narcosis. Such an approach makes it possible, on the one hand, not to change the organization of outpatient phlebological care and on the other hand to refuse from involving anaesthesiological support. Besides, it is absolutely safe in relation to the risk for the development of allergic reactions.

KEY WORDS: endovenous laser obliteration, local anaesthesia, allergy.

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