Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins.
BACKGROUND
Endovenous laser ablation (EVLA) is a minimally invasive technique for treating varicose veins due to truncal vein incompetence. This randomized trial compared EVLA with conventional surgery in patients with primary saphenofemoral and great saphenous vein (GSV) reflux.


METHODS
Consecutive consenting patients with symptomatic varicose veins were randomized to EVLA 1 (stepwise laser withdrawal), EVLA 2 (continuous laser withdrawal) or surgery (saphenofemoral ligation, GSV stripping, multiple phlebectomies). Principal outcome measures were abolition of GSV reflux and improvement in Aberdeen Varicose Vein Symptom Score (AVVSS) 3 months after treatment.


RESULTS
GSV reflux was abolished in 41 of 42 legs treated with EVLA 1, 26 of 29 following EVLA 2 and 28 of 32 after surgery (P = 0.227). The median (interquartile range, i.q.r.) AVVSS improvement was similar: 9.38 (4.54-14.93) with EVLA 1, 10.26 (5.03-15.03) after EVLA 2 and 8.36 (4.54-13.21) following surgery (P = 0.694). Return to normal activity (median (i.q.r.) 2 (0-7) versus 7 (2-26) days; P = 0.001) and work (4 (2-7) versus 17 (7.25-33.25) days; P = 0.005) was quicker after EVLA by either method.


CONCLUSIONS
Abolition of reflux and improvement in disease-specific quality of life was comparable following both EVLA and surgery. The earlier return to normal activity following EVLA may confer important socioeconomic advantages.


BACKGROUND
ISRCTN99270116 (http://www.controlled-trials.com).
Darwood
R J
RJ
Leeds Vascular Surgical Institute, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK. rosie_darwood@btinternet.com
Theivacumar
N
N
Dellagrammaticas
D
D
Mavor
A I D
AI
Gough
M J
MJ
D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D012501:Saphenous Vein / Q000601:surgery*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014648:Varicose Veins / Q000601:surgery*; D014689:Venous Insufficiency / Q000601:surgery
D000700:Analgesics