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

## TL;DR

This case series shows that zone-zero laser crossectomy during EVLA is a safe and effective method for treating chronic venous insufficiency with low complication rates.

## Contribution

The study presents a novel zone-zero ablation technique to reduce recurrence in EVLA for great saphenous vein insufficiency.

## Key findings

- No recanalization was observed in 57 patients during 3 months of follow-up.
- Postoperative complications were mild and occurred in less than 10% of cases.

## Abstract

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.

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.

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.

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.