Barw Barw Medical Journal 2960-1959 3 3 2025 06 02 Management of Lower Limb Varicose Veins Using Endovenous Laser Ablation, Micro-Phlebectomy, and Sclerotherapy Using Multimodal Analgesia 20 25 10.58742/bmj.v3i3.193 eng Fahmi H. Kakamad College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. fahmi.hussein@univsul.edu.iq Fuad E. Fuad Department of Anesthesiology, Shar Hospital, Malik Mahmud Ring Road, Sulaymaniyah, Iraq. fuad.fuad@gmail.com Soran H. Tahir College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. soran.tahir@univsul.edu.iq Ayoob A. Mohammed College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. ayoob.mohammed@gmail.com Rezheen J. Rashid Department of Radiology, Hiwa Cancer Hospital, Sulaimani Directorate of Health, Sulaymaniyah, Iraq. rezheen.rashid@gmail.com Hiwa O. Abdullah Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. hiewaom96@gmail.com Dana H. Mohammed Saeed College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. dana.saeed@gamil.com Kanaw A. Salih Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. kanaw.salih@gmail.com Nsren S. Sabr Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. nsren.sabr@gmail.com Farman J. Ahmed Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. farman.ahmed@gmail.com Bzhwen Y. Abdulla Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. bzhwen.yassen@gmail.com Pavel M. Kareem Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. pavel.kareem@gmail.com Marwan N. Hassan Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. marwan.nasih12@gmail.com Shno J. Jabbar Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. shno.jabar@gmail.com Berun A. Abdalla Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. berun.anwer95@gmail.com Bander A. Abdalla Kscien Organization for Scientific Research (Middle East Office), Azadi mall, Hamdi Street, Sulaymaniyah, Iraq. bander.abdalla@gmail.com Amr M. Mahmood Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. amr.mahmood@gmail.com 2025 04 10 Introduction Previously, the conventional surgical procedure of high-ligation and saphenous stripping was commonly used to treat varicose veins (VVs). However, contemporary advancements have led to the rapid evolution of VV management. This study shares a single center's experience in treating patients with lower limb VVs through endovenous laser ablation in combination with phlebectomy and sclerotherapy using multimodal analgesia. Methods This case series study included consecutive patients diagnosed with lower limb VVs. The inclusion criteria encompassed VVs categorized from score C1 to C6 (clinical, etiologic, anatomic, and pathophysiological), saphenofemoral incompetence, and patients aged between 18 and 75. Results A total of 153 patients were enrolled. The majority were female (73.0%), resulting in a female-to-male ratio of 2.73:1. The age of patients ranged from 18 to 73 years, with a mean age of 40.8 ± 11.7 years. Regarding post-procedural complications, wounds developed in 25 patients (16.3%), making it the most common complication, while thrombophlebitis occurred in 15 cases (9.8%), skin discoloration in nine cases (5.9%), and recanalization and DVT each in a case (0.7%). Due to extensive varicose veins, 31 patients (20.0%) required a sclerotherapy session six weeks after the operation. Patients could return to routine daily activities within 4 to 10 hours. Overall, the patient satisfaction rate (complete and partial) was 85%. Only a case of recurrence (0.7%) was reported after a one-year follow-up. Conclusion Endovenous laser ablation, in combination with phlebectomy and sclerotherapy using multimodal analgesia, may yield a satisfactory outcome in patients with moderate to severe VVs.