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

<b>Background:</b> Treating varicosities originating from a popliteal fossa perforating vein (PFPV) is challenging due to their proximity to nerves and complex morphology. Data on endovenous laser ablation (EVLA) for PFPV varicosis are limited. <b>Methods:</b> This retrospective, single-center study reviewed all primary varicose vein surgeries from May 2021 to December 2024. Only primary PFPV varicosis cases with CEAP stage C2s or higher were included. Patients with recurrent disease or primary truncal insufficiency due to reflux from the saphenopopliteal junction were excluded. EVLA was performed using 1470 nm radial laser catheters, targeting the reflux source and downstream varicose segments. Tumescent solution was applied to protect the surrounding structures. The primary outcome was early technical success via duplex ultrasound; the secondary outcome was the complication rate. <b>Results:</b> Of the 2375 limbs treated, 44 (1.9%) involved PFPV. The cohort included 16 men (36%) and 28 women (64%), with a mean age of 54. The median follow-up was 14 days. Technical success was achieved in 41 cases (93.2%). Foam sclerotherapy with polidocanol was performed in eight 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. <b>Conclusions:</b> EVLA shows promising very early technical efficacy, with low morbidity, for treating PFPV varicosis. Based on our findings, prospective studies investigating the mid- and long-term outcomes of this technique are warranted to further validate its clinical utility.