Outcomes of endovenous laser ablation in patients with incompetent Giacomini vein

BACKGROUND: Giacomini vein (GV) incompetence is an uncommon cause of chronic venous disease, and evidence regarding its endovenous treatment remains limited. This study evaluated the clinical and duplex ultrasound outcomes of endovenous laser ablation (EVLA) in patients with incompetent GV. METHODS: This prospective single-center study included 83 limbs in 75 consecutive patients treated with EVLA for symptomatic GV incompetence between January 2018 and January 2024. Diagnosis and reflux assessments were performed using duplex ultrasound study. Clinical severity was classified according to the Clinical-Etiology-Anatomy-Pathophysiology classification, whereas clinical outcomes and quality of life (QOL) were assessed using the Venous Clinical Severity Score (VCSS) and the Venous Insufficiency Epidemiological and Economic Study-QOL questionnaire. The primary outcome was complete vein occlusion. Secondary outcomes included technical success, symptom improvement, recanalization, and complications. Follow-up was performed at 1, 6, and 12 months, and annually thereafter. RESULTS: Technical success and immediate postprocedural occlusion were achieved in all treated limbs (100%). The mean follow-up period was 28.3 ± 16.3 months. The overall occlusion rate at the latest follow-up was 96.4% (80/83 limbs). Partial and complete recanalization occurred in two (2.4%) and one (1.2%) limbs, respectively. Mean Venous Clinical Severity Score significantly improved from 6.9 ± 1.4 at baseline to 2.1 ± 1.4 at 12 months, whereas mean Venous Insufficiency Epidemiological and Economic Study-QOL score increased from 50.4 ± 4.8 to 78.7 ± 6.1 (both P < .001). No major complications, including deep vein thrombosis, pulmonary embolism, or endothermal heat-induced thrombosis, were observed. Kaplan-Meier estimated freedom from recanalization was 95.6% at 48 months. CONCLUSIONS: In this prospective single-center cohort, EVLA of the incompetent GV was associated with high technical success, durable occlusion, clinical improvement, and a low complication rate. Further comparative studies are needed to define its role relative to other endovenous treatment modalities.