Challenges in advancing the laser fiber through the great saphenous vein during endovenous ablation and strategies to overcome them

Objectives: To determine the incidence of possible obstacles and patients’ characteristics when performing endovenous laser treatment (EVLT) and suggestions to improve the ability to overcome them. Method: A prospective study with 215 limbs treated with EVLT. A sequence of maneuvers was performed to move the fiber forward when difficulty was found and if unsuccessful another entry site was punctured. Results: In 29 of 215 (13.48%) limbs, resistance was encountered while navigating the fiber; 16 (55.17%) solved with lower limb extension; 13 (44.82%) needed ultrasound guided maneuvers; five (17.24%) needed a saline flush and in three patients (10.34%) another entry site was necessary. In 214 of 215 cases (99.53%), ablation was accomplished and no complications were observed. Conclusions: Both obstruction and higher patients' BMI are the main obstacles during endovenous laser ablation and usually needs additional maneuvers to accomplish the procedure in our study and the use of tricks to overcome these issues is feasible.