Assessment of the level of difficulty of four techniques of endovenous thermal ablation of the great saphenous vein and the echogenicity of the tip of the working device in vivo.

Background: To compare the level of difficulty of four techniques of endovenous thermal ablation (EVTA) of the great saphenous vein and the echogenicity of the tip of the working device in vivo.

Methods: Sixty patients qualified to the EVTA of the great saphenous vein were randomly assigned to treatment with an 810-nm axial diode laser [endovenous laser ablation (EVLA) 810] with two different delivery systems: 4-F introducer, 0.018" guidewire, 22-G needle (EVLA810-1) and 4-F introducer, 0.035" guidewire, 19-G needle (EVLA810-2); a 1470-nm radial diode laser (EVLA1470); or radiofrequency ablation (RFA; ClosureFAST). The level of difficulty of four stages of the procedure-cannulation of a vein, advancement of the working part to the saphenofemoral junction (SFJ), visualization of a tip of the working part at SFJ, and difficulty of performing the ablation and delivering the planned linear energy density-was subjectively assessed. An objective comparison of visibility of working parts in ultrasonography was performed with analysis of grayscale median.

Results: The cannulation of a distal segment of the obliterated vein was the most difficult in EVLA810-1, P = 0.015. The delivery of a working part to the SFJ was the least problematic in RFA and EVLA1470, P = 0.024. The visualization of the working tip at the SFJ was the most difficult in RFA, P = 0.028. The application of desired amount of energy was the easiest in RFA, P = 0.038. The EVLA1470 presented the best echogenicity.

Conclusions: Although all the examined techniques have advantages and disadvantages, EVTA with the 1470-nm diode laser with radial optic fiber seems to be the easiest.