title: Endovenous laser ablation: does standard above-knee great saphenous vein ablation provide optimum results in patients with both above- and below-knee reflux? A randomized controlled trial.
abstract: BACKGROUND
  Following above-knee (AK) great saphenous vein (GSV) endovenous laser ablation (EVLA) 40% to 50% patients have residual varicosities. This randomized controlled trial (RCT) assesses whether more extensive GSV ablation enhances their resolution and influences symptom improvement.
  
  
  METHODS
  Sixty-eight limbs (65 patients) with varicosities and above and below-knee GSV reflux were randomized to Group A: AK-EVLA (n = 23); Group B: EVLA mid-calf to groin (n = 23); and Group C: AK-EVLA, concomitant below-knee GSV foam sclerotherapy (n = 22). Primary outcomes were residual varicosities requiring sclerotherapy (6 weeks), improvement in Aberdeen varicose vein severity scores (AVVSS, 12 weeks), patient satisfaction, and complication rates.
  
  
  RESULTS
  EVLA ablated the treated GSV in all limbs. Sclerotherapy requirements were Group A: 14/23 (61%); Group B: 4/23 (17%); and Group C: 8/22 (36%); chi2 = 9.3 (2 df) P = .01 with P(A-B) = 0.006; P(B-C) = 0.19; P(A-C) = 0.14. AVVSS scores improved in all groups as follows: A: 14.8 (9.3-22.6) to 6.4 (3.2-9.1), (P < .001); B: 15.8 (10.2-24.5) to 2.5 (1.1-3.7), (P < .001); and C: 15.1 (9.0-23.1) to 4.1 (2.3-6.8), (P < .001) and P(A-B) = 0.011, P(A -C) = 0.042. Patient satisfaction was highest in Group B. BK-EVLA was not associated with saphenous nerve injury.
  
  
  CONCLUSIONS
  Extended EVLA is safe, increases spontaneous resolution of varicosities, and has a greater impact on symptom reduction. Similar benefits occurred after concomitant BK-GSV foam sclerotherapy.
authors.affiliation: Leeds Vascular Institute, The General Infirmary at Leeds, Leeds, United Kingdom.
authors.forename: Nadarajah S
authors.initials: NS
authors.lastname: Theivacumar
authors.forename: Demos
authors.initials: D
authors.lastname: Dellagrammaticas
authors.forename: Andrew I D
authors.initials: AI
authors.lastname: Mavor
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gough
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000601:surgery*; D015911:Sclerotherapy; D014648:Varicose Veins / Q000601:surgery*; D014689:Venous Insufficiency / Q000601:surgery