Incidence of Sural Nerve Injury following Endovenous Laser Ablation of the Short Saphenous Vein: A Prospective Observational Study

Abstract

Background: Endovenous laser ablation (EVLA) is now the treatment of choice for symptomatic short saphenous vein (SSV) reflux, but the close anatomical relationship between the SSV and the sural nerve places the nerve at risk of thermal injury. Reported rates of post-operative paraesthesia vary widely, and the natural history of nerve recovery is poorly characterised in prospective cohorts. Materials and Methods: In this prospective observational study, 50 consecutive adult patients undergoing 1470-nm radial-fibre EVLA for symptomatic SSV reflux (with or without saphenopopliteal junction incompetence) at a tertiary-care teaching hospital were followed for 3 months. CEAP classification, vein diameter and delivered laser energy were recorded. Patients were assessed for numbness, tingling and burning pain along the sural nerve distribution at post-operative day (POD) 0, POD 1, 1 week, 1 month and 3 months; symptoms persisting beyond 1 month were further evaluated with nerve conduction studies (NCS). Associations between sural nerve injury and age, sex and CEAP subclass were analysed using Fisher's exact test. Results: Mean age was 45.7 ± 11.6 years (range 18–79) with a male predominance (72%). Mean SSV diameter was 3.66 ± 0.83 mm and mean energy delivered was 1171.4 ± 124.8 J. Sural nerve symptoms occurred in 5/50 patients (10%; 95% CI 4.3–21.4%), most commonly numbness (6%) and burning pain (4%) at POD 1 and 1 week. Symptoms resolved completely within 1 month in 4 of 5 patients; 1 patient (2%) had persistent injury confirmed on NCS at 3 months. No significant association was found between injury and age, sex, or CEAP classification (all p>0.05), though injury rates were numerically higher in C4 disease. Conclusion: EVLA of the SSV, performed with energy titration and generous ultrasound-guided tumescent anaesthesia, carries a modest and largely self-limiting risk of sural nerve injury, with the great majority of cases resolving within 1 month on conservative management.