Endovenous Laser Ablation of the Saphenous Veins: Bilateral Versus Unilateral Single-session Procedures Bertrand Janne d’Othée, MD, MPH, Salomao Faintuch, MD, Todd Schirmang, MD, and Elvira V. Lang, MD PURPOSE: To assess the feasibility of bilateral endovenous laser ablation (EVLA) of saphenous veins in a single session with use of diluted lidocaine for tumescent anesthesia. MATERIALS AND METHODS: Among 122 consecutive EVLA procedures (112 patients; mean age, 49 years; 75% women) over a 12-month period, there were 75 unilateral procedures (n  67) and 47 bilateral interventions (n  45). Tumescent anesthesia consisted of lidocaine diluted to 0.10% for unilateral procedures versus 0.05% for bilateral cases (lidocaine dose <4.5 mg/kg body weight). Procedural data, immediate success rates on an intent-to-treat basis, and outcomes at 3– 6-month follow-up were compared between groups with nonparametric tests. RESULTS: Bilateral procedures could be performed successfully with low lidocaine dilutions with a similar success rate (96%) as unilateral procedures (100%). No significant variation in systolic and diastolic blood pressure and heart rate was observed between bilateral and unilateral groups. No patient experienced signs of lidocaine toxicity. After adjusting for length of vein treated, there were no significant differences in the total lidocaine dose used, tumescent anesthesia volume, or procedure duration. CONCLUSIONS: Bilateral saphenous vein ablation in a single session appears safe and effective when tumescent anesthesia is given with very dilute lidocaine (0.05%). This approach may help meet patients’ requests for simulta- neous bilateral treatment and reduce duration of postprocedural discomfort. J Vasc Interv Radiol 2008; 19:211–215 Abbreviations: EVLA = endovenous laser ablation, GSV = great saphenous vein ENDOVENOUS radiofrequency and endovenous laser ablation (EVLA) techniques are gaining popularity for the treatment of incompetent saphe- nous veins (1,2). Outpatient treatment and short recovery are attractive to pa- tients (3). In our experience, many can- didates for bilateral saphenous vein ablation request to have both legs treated in a single session. A limitation to this approach lies in the potential for lidocaine toxicity that may arise when a large amount of tumescent an- esthesia is required (4,5). When the total length of the venous segments to ablate is small, bilateral treatment can easily be performed in a single session. However, for longer segments of the great saphenous vein (GSV) system, many practitioners are reluctant to perform same-day bilateral treatment. As a result of overwhelming patient demand, we started performing bilat- eral, single-session procedures with use of low lidocaine dilutions for tu- mescent anesthesia that would pro- vide appropriate patient comfort level and reduced risks of drug toxicity. Herein we report our experience with bilateral EVLA of the saphenous veins performed in a single session and compare it versus unilateral EVLA procedures in terms of feasibility and efficacy, with special attention to com- plications related to local anesthetic toxicity. MATERIALS AND METHODS Patients This was a retrospective study of all consecutive EVLA procedures per- formed over a 1-year period at a single institution. As part of the quality as- surance criteria of our routine practice, all data reported here were encoded prospectively in our database. Our in- stitutional review board approved the retrospective analysis of these data. In- formed consent for the procedure was obtained from all patients. Ablation From the Department of Radiology, Beth Israel Dea- coness Medical Center–Harvard Medical School, Boston, Massachusetts. Received April 23, 2007; final revision received and accepted September 9, 2007. Address correspondence to B.J.D., Department of Radiology, Cardiovascular Imaging and Interven- tion, Massachusetts General Hospital–Harvard Medical School, 55 Fruit St, GRB-290, Boston, MA 02114-2696; E-mail: bjannedothee@partners.org None of the authors have identified a conflict of interest. © SIR, 2008 DOI: 10.1016/j.jvir.2007.09.010 211