Similar Outcomes for 2 Varicose Vein Repair Techniques

Laura Newman

September 19, 2011

September 19, 2011 — Endovenous laser ablation treatment (EVLT) and high ligation with stripping (HLS) of the great saphenous vein have comparable outcomes on most indicators at 2 years, according to the largest 2-year randomized trial yet performed on the repair of chronic venous insufficiency.

However, in the study, published online September 19 in the Archives of Dermatology, the researchers found a significantly greater rate and more severe course of duplex-detected saphenofemoral recurrences in the EVLT group (17.8% vs 1.3%; P < .001) at 2 years.

Both procedures improved the Homburg Varicose Vein Severity Score and Chronic Venous Insufficiency Questionnaire, which measures disease-related quality of life, to a similar degree. EVLT resulted in more adverse effects (phlebitis reactions, dyspigmentation, and tightness), but this was offset by superior recovery, cosmetic outcome, and hemodynamics. Patients reported high levels of satisfaction with both procedures.

Between September 2004 and March 2007, the Randomized Study Comparing Endovenous Laser Ablation with Crossectomy and Stripping of the Great Saphenous Vein randomly assigned patients with great saphenous vein insufficiency to receive EVLT vs HLS, with 185 patients assigned to EVLT and 161 to HLS. Patients were treated on an ambulatory basis at 2 German study centers (Homburg and Bad Bertrich). Investigators randomly assigned only 1 limb per patient. In cases where both limbs were eligible, they chose the limb with worse involvement for the randomization. Knuth Rass, MD, from the Department of Dermatology at Saarland University Hospital, Homburg, led the trial.

Investigators evaluated all patients before and after the procedure, using Society for Vascular Surgery and International Society for Cardiovascular recommendations classification schema for clinical, etiologic, anatomic, and pathological criteria, and the Homburg Varicose Vein Severity Score, which includes refilling time. They performed full venous ultrasonography on all patients, with detailed duplex mapping.

The primary outcome was recurrent varices after surgery. Patients were evaluated at postoperative day 7, 3 months, 1 year, and 2 years. Of the initial 400 patients selected for the trial, 54 patients decided not to be randomized because they had a preference for one of the treatments, and 30 patients were lost to follow-up.

The rate of clinically recurrent varicose veins after surgery was not significantly different in the 2 treatment groups. There were no major complications in either group. Posttreatment results on the Homburg Varicose Vein Severity Score were comparable in the 2 treatment groups. However, more patients in the EVLT group reached normalized venous refilling, according to digital photoplethysmography. At 3 months, disease-specific quality of life, as measured by the Chronic Venous Insufficiency Questionnaire, revealed improvement in both groups, with continuing improvements in the HLS group up to 12 months after surgery (P = .01).

Patient satisfaction in both groups was excellent, but patients in the EVLT group rated their cosmetic outcome at 2 years as significantly better. Recovery was similar in both groups, at 4.8 days (EVLT) vs 4.0 days (HLS; P = .13). Return to work was shorter in the EVLT group, at 10.4 days compared with 11.8 days in the HLS group (P = .02).

The authors have disclosed no relevant financial relationships.

Arch Dermatol. Published online September 19, 2011. Abstract

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