Successful single-center experiences of laser crossectomy in zone zero in Endovenous Laser Ablation (EVLA) for chronic venous insufficiency - a case series.

BACKGROUND

Chronic venous insufficiency (CVI) is a prevalent and underdiagnosed disease affecting over 25 million adults worldwide. Endovenous laser ablation (EVLA) remains the gold standard for great saphenous vein (GSV) insufficiency. However, conventional EVLA performed 1-2 cm distal to the saphenofemoral junction (SFJ) often leaves residual tributaries, increasing the risk of recurrence. Zone-zero laser crossectomy, defined as laser crossectomy performed exactly at the 0 cm zone of the SFJ (zone-zero ablation), had been proposed as a minimally invasive alternative technique to eliminate residual stumps and reduce varicose vein recurrence. This case series of zone-zero laser crossectomy aims to share our experiences and outcomes amongst 57 patients in our center.

METHODS

A total of 57 consecutive patients with symptomatic GSV insufficiency (CEAP C2-C6) underwent EVLA using a 1470 nm radial double-ring swift laser with zone-zero ablation at the SFJ. Procedural parameters, complications, and postoperative outcomes were recorded. Patients were followed at 7 days, 4, 8, and 12 weeks with physical and duplex ultrasound examinations.

RESULTS

The mean age was 61.6 years. No recanalization was observed during the 3-month follow-up, with duplex ultrasound confirming complete obliteration of treated GSVs. Postoperative complications included leg pain in 3 cases (5.26%), EHIT grade I-II in 1 case (1.75%), hyperpigmentation in 1 case (1.75%), and paresthesia in 1 case (1.75%). All complications were mild and managed conservatively.

CONCLUSIONS

Zone-zero laser crossectomy is a safe and effective modification of EVLA for GSV insufficiency, demonstrating high obliteration rates and low complication rates. Larger cohorts with longer follow-up are needed to confirm durability.