The impact of "flush" endovenous laser ablation on thromboembolic risk: a retrospective safety analysis.

Abstract

ObjectiveEndovenous laser ablation (EVLA) is standard for superficial venous insufficiency. This retrospective study evaluates the safety profile of "flush" EVLA, assessing whether thermal ablation directly at the saphenofemoral junction (SFJ) increases postoperative thromboembolic complications like deep vein thrombosis (DVT) and pulmonary embolism (PE).MethodsWe retrospectively analyzed 501 patients (281 female; mean age 45.8 ± 8.2 years) undergoing "flush" EVLA via a 1470-nm dual-radial laser (ELVeS Radial 2ring™, Biolitec) between February 2023 and June 2025. Unlike traditional sub-junctional positioning, laser delivery was initiated flush with the SFJ origin under tumescent anesthesia. Postoperative chemical anticoagulation was routinely omitted. Patients wore Class 2 compression stockings and were followed for six months. Systemic thromboembolic events were tracked nationwide using the National Electronic Health Record Database (e-Nabız), which mandatorily integrates data across all public, university, and private healthcare facilities in Turkiye to ensure complete cross-institutional complication ascertainment.ResultsNo patient developed DVT or PE during six-month follow-up (0% incidence). One patient (0.2%) experienced localized superficial thrombosis in a calf tributary at day 10, successfully managed via ambulatory phlebectomy without systemic sequelae. Low-grade endovenous heat-induced thrombosis (EHIT Class 1-2) occurred in 12 patients (2.4%) and resolved spontaneously. This absence of major thromboembolic phenomena confirms a favorable safety profile.Conclusion"Flush" EVLA using a 1470-nm dual-radial catheter is safe and carries a negligible risk of major thromboembolic events. Eliminating the proximal saphenous stump at the SFJ line does not increase DVT or PE incidence, even without chemical anticoagulation. The utilization of nationwide integrated digital tracking further validates the longitudinal completeness of outcome ascertainment.