Behnam Ghorbani - Department of Surgery, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Saba Mohammadzadeh - School of Medicine, Tehran university of Medical Sciences, Tehran, Iran
Morteza Noaparast - Department of Surgery, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

EVLT and sclerotherapy are relatively new in the field of management of varicose veins and reflux. a two-step management of varicose veins by EVLT and subsequent sclerotherapy is not extensively studied in the literature. Thus, we aimed to evaluate and compare the clinical outcomes of one-step EVLT and two-step EVLT and sclerotherapy in treatment of below-knee varicose veins. This prospective study was performed from October ۲۰۲۰ to October ۲۰۲۱ at Imam Khomeini Hospital of Tehran. Patients with proved varicose veins of lower extremity were recruited for the study. All patients underwent endovascular laser ablation in SFJ and GSV regions at first step. After ۴۸ hours of EVLT, color Doppler ultrasonography was done to rule out DVT. After four weeks, they were evaluated by physical examination and Doppler ultrasonography. In cases with remaining clinical or paraclinical evidence of varicose veins in below-knee veins, foam sclerotherapy was performed. Patients who had undergone sclerotherapy in the second step then underwent physical examination and Doppler ultrasonography. Demographic and baseline parameters were recorded. Ultrasonographic parameters, CEAP and VCSS were evaluated at three time-periods of baseline, one month after EVLT and one month after sclerotherapy. Mean age of patients was ۴۶.۶۷±۱۳.۳۱ years. ۴۳ limbs (۵۲.۴%) were for male patients while ۳۹ limbs (۴۷.۶%) were for female participants. Pain and visible varicose veins were the most common complaints. Significant improvements in ultrasonographic parameters, CEAP and VCSS were seen after one-step EVLT and two-step combined EVLT and sclerotherapy (p<۰.۰۵). A two-step strategy with initial EVLT and deferred sclerotherapy in selected patients with below-knee varicose veins can yield remarkable results comparable to the results of treatments of above-knee varicose veins previously reported in the literature.

EVLT, Sclerotherapy, Varicose, CEAP, VCSS