Treating Popliteal Fossa Perforating Vein Varicosis with Endovenous Laser Ablation: A Single-Center Observational Study

Background: The treatment of varicosities originating from popliteal fossa perforating vein (PFPV) is challenging due to their proximity to nerve structures and unique morphology. Limited data exists on the use of endovenous laser ablation (EVLA) for these cases. Methods: This retrospective, single-center study reviewed all primary surgeries from May 2021 to December 2024. Only primary PFPV varicosis cases with CEAP stage C2s or higher were included. Recurrent cases and those with primary truncal insufficiency were excluded. Treatments were performed with 1470 nm radial emitting laser catheters. Ablation targeted the proximal source of reflux and the downstream varicose segments. Tumescent solution was used to protect nerve structures and skin. The primary outcome was ablation success, assessed with duplex ultrasonography. The secondary outcome was complication incidence. Results: Of 2375 limbs treated for primary varicose veins, 44 (1.9%) involved PFPV. The cohort included 16 males (36%) and 28 females (64%), with a mean age of 54 years. The median follow-up was 14 days. Technical success was achieved in 41 of 44 cases (93.2%). Foam sclerotherapy was performed in 8 patients (18.2%) exclusively for superficial residual varicosities and never simultaneously with EVLA. Three treatment failures required re-operation, two of which were successfully re-treated. Minor postoperative complications occurred in two patients (4.5%). No nerve injuries or thrombotic events were observed. Conclusion: EVLA using a 1470 nm diode laser demonstrates promising early outcomes with low morbidity for treating PFPV varicosis. By eliminating the central reflux source, EVLA creates a hemodynamic condition that either leads to the regression of superficial varicosities or facilitates their treatment with foam therapy. Early redo procedures in cases of treatment failure can further improve long-term success.