Endovenous Laser Treatment vs. Vein Stripping

George J. Hruza, MD

Journal Watch. 2006;5(2) 

Summary

Patients with saphenofemoral junction insufficiency and great saphenous vein (GSV) reflux can be treated conventionally by stripping of the saphenous vein or by a newer strategy of endovenous laser or radiofrequency coagulation. Which approach is better? In this prospective, bilateral comparison study from Germany, 20 patients with bilateral GSV insufficiency diagnosed by duplex ultrasound underwent different treatments of each leg: After bilateral high ligation of the GSV, they received traditional saphenous vein stripping in one leg and endovenous 810-nm diode-laser photocoagulation in the other. Other varicose veins in both legs then underwent miniphlebectomy.

The degree of postoperative pain was slight to absent, without treatment-related differences. Forty percent of patients had edema on the vein-stripping side, but only 15% had it on the laser side. Sixty percent developed large ecchymoses on the vein-stripping side, but only 20% did on the laser side. All patients were satisfied with the results in both legs at 1 and 2 months after surgery. When asked which result they preferred, 70% of patients picked the laser side. No significant complications were noted in either side. Air plethysmography at 2 months documented improved venous filling time in all treated limbs.

Comment

Endovenous laser treatment of the great saphenous vein was just as effective as traditional vein stripping but produced less postoperative swelling and bruising. The use of longer-wavelength lasers, such as the 1320-nm Nd:YAG, that target water rather than hemoglobin, should further reduce bruising (see JW Dermatol Jan 31, 2006). Unlike traditional vein stripping, endovenous laser treatment can be done under tumescent local anesthesia, making it a practical procedure for surgically oriented dermatologists.

— George J. Hruza, MD

Source

de Medeiros CA and Luccas GC. Comparison of endovenous treatment with an 810 nm laser versus conventional stripping of the great saphenous vein in patients with primary varicose veins. Dermatol Surg 2005 Dec; 31:1685-94.


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