title: Evolution of an endovenous laser ablation practice for varicose veins.
abstract: OBJECTIVE
  We aimed to assess the evolution of an endovenous laser ablation (EVLA) practice in the management of varicose veins in a university teaching hospital vascular surgical unit, over five years.
  
  
  METHODS
  This was a retrospective review of a prospectively collected database of patients undergoing EVLA for great saphenous vein incompetence and followed up for a year. For inter- and intragroup comparison, patients were divided into three groups: group A: endovenous access generally established at the perigenicular level (n = 105); group B: when practice changed to gain access at lowest point of demonstrable reflux (n = 70); and group C: when tumescence delivery changed from manual injections to delivery via peristaltic pump (n = 49). Outcomes including pain scores, time taken to return to normal functioning, quality of life (QoL), venous clinical severity scores (VCSS) and complication rates were evaluated.
  
  
  RESULTS
  Intergroup analysis: increase in the length of vein treated and laser density delivered was observed over time, even as median procedure duration decreased (P < 0.001). An increase in sensory disturbance was noticed in group C (P = 0.047) while better Aberdeen Varicose Vein Questionnaire (AVVQ) (P = 0.004), SF-36(®) physical domains (P < 0.05) and patient satisfaction with treatment (P = 0.025) were recorded in the same group at 52 weeks. No significant difference was observed in technical failure, pain scores, return to normal functioning, VCSS and recurrence rates post-intervention. Intragroup analysis: QoL measures (AVVQ, SF-36(®), EQ-5D) and VCSS scores demonstrated significant improvement at 12 and 52 weeks compared with baseline (P < 0.05).
  
  
  CONCLUSIONS
  Increase in length of vein treated and energy delivery seems to improve short-term outcomes; however, operators need to be wary of a possible concurrent increase in paraesthetic complications.
authors.affiliation: Hull York Medical School/University of Hull - Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull HU3 2JZ, UK. nehemiah.samuel@hey.nhs.uk
authors.forename: N
authors.initials: N
authors.lastname: Samuel
authors.forename: T
authors.initials: T
authors.lastname: Wallace
authors.forename: D
authors.initials: D
authors.lastname: Carradice
authors.forename: G
authors.initials: G
authors.lastname: Smith
authors.forename: F
authors.initials: F
authors.lastname: Mazari
authors.forename: I
authors.initials: I
authors.lastname: Chetter
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D007834:Lasers; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000473:pathology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014648:Varicose Veins / Q000628:therapy*