Endovenous Laser Treatment in Patients with Advanced CVI

As a result of the trophic changes in the distal third of their shank, patients in Advanced CVI stages are not suitable for conventional stripping. Incisions in areas with disrupted trophics should not be performed because of the risk of slow wound healing. This paper is based on the results of the endovenous laser treatment (EVLT) of 23 patients with advanced disease with trophic changes in the distal third of the shank. In all of these patients incompetent valves of GSV in the shank segment as well as insufficiency of the perforant veins have been detected preoperatively. This gave us the opportunity to follow the proximal laser ablation of the thigh segment of GSV to perform through the same access point laser ablation of the shank segment in the distal retrograde direction. In all of these patients GSV has been exteriorized proximally over the trophic changes and ante- and retrograde laser ablation has been performed with great results. Retrograde laser ablation has been successful in all cases due to the incompetent GSV valves in its shank segment. Thus, without access to an area of disturbed trophicity, the low vein-venous reflux is effectively stopped.