Ways to improve EVLA: factors ensuring stable occlusion of the great saphenous vein's terminal segment

Introduction. Endovenous laser ablation is the most widely used method for treating lower extremity varicose veins. One primary cause of disease recurrence is pathological reflux persistence in the sapheno-femoral junction. Identifying factors affecting occlusion stability in the great saphenous vein's proximal segment may optimize surgical techniques and improve outcomes.Aim. To identify clinical and tactical-technical factors influencing the effectiveness of endovenous laser ablation in achieving stable occlusion of the great saphenous vein's proximal segment in the sapheno-femoral junction.Materials and methods. 'This prospective study involved 546 patients (692 limbs) with varicose veins treated by endovenous laser ablation. A novel method assessed occlusion effectiveness in the great saphenous vein's proximal segment. Twenty-one factors were analyzed, including 8 quantitative and 13 qualitative variables. Data were processed using descriptive statistics and gamma correlation analysis.Results. High effectiveness (90,9 %) was achieved within 30 days post-procedure. Moderate correlations were observed with factors like manual traction technique for the laser fiber (y=0,495564), linear energy density >100 J/cm (y=0,459682), and specific energy density >40 J/cm2 (y=0,41604). Mid-term results showed that in 35,6 % of cases, pathophysiological conditions promoting varicose vein progression persisted in the sapheno-femoral junction.Conclusion. Endovenous laser ablation is highly effective for achieving stable occlusion of the great saphenous vein's sapheno-femoral junction. Several controllable factors significantly impact the procedure's success, offering opportunities for improved outcomes.