title: Randomized clinical trial comparing endovenous laser ablation and stripping of the great saphenous vein with clinical and duplex outcome after 5 years.
abstract: OBJECTIVE
  This is the first randomized controlled trial with a 5-year follow-up comparing endovenous laser ablation (EVLA) with high ligation and pin-stripping in patients with great saphenous vein (GSV) incompetence.
  
  
  METHODS
  One hundred twenty-one consecutive patients (137 legs) with GSV incompetence were randomized to EVLA (980 nm bare fiber) or high ligation and stripping using tumescent local anesthesia with light sedation. Mini-phlebectomies were performed in all patients. The patients were examined with duplex scanning before treatment and after 12 days, and then after 1, 3, and 6 months, and yearly thereafter for up to 5 years. The primary end point was open refluxing GSV. Secondary end points were recurrent varicose veins, frequency of reoperations, Venous Clinical Severity Score, and quality of life scores (Aberdeen Varicose Vein Symptoms Severity Score and Short Form-36).
  
  
  RESULTS
  In the EVLA and stripping group, nine (Kaplan-Meier [KM] estimate, 17.9%) and four (KM estimate, 10.1%) of GSVs had open refluxing segments of 5 cm or more (ns). Clinical recurrence was recorded in 24 (KM estimate, 46.6%) and 25 (KM estimate, 54.6%), whereas reoperations were performed in 17 (KM estimate, 38.6%) and 15 (KM estimate, 37.7%) legs (ns). Venous Clinical Severity Score and Aberdeen Varicose Vein Symptoms Severity Score improved whereas Medical Outcomes Study Short Form-36 quality of life score improved in several domains in both groups with no difference between the groups.
  
  
  CONCLUSIONS
  Five-year follow-up of our randomized controlled trial comparing EVLA with open surgery in patients with GSV incompetence did not show any significant difference between the two groups in primary or secondary end points, perhaps because of the small sample size. EVLA seems to be a valid alternative to open surgery.
authors.affiliation: Danish Vein Centers, Åreknudeklinikken, and Surgical Center Roskilde, Naestved, Denmark. larshrasmussen@yahoo.com
authors.forename: Lars
authors.initials: L
authors.lastname: Rasmussen
authors.forename: Martin
authors.initials: M
authors.lastname: Lawaetz
authors.forename: Lars
authors.initials: L
authors.lastname: Bjoern
authors.forename: Allan
authors.initials: A
authors.lastname: Blemings
authors.forename: Bo
authors.initials: B
authors.lastname: Eklof
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000772:Anesthesia, Local; D003718:Denmark; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D053685:Laser Therapy; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D012501:Saphenous Vein / Q000000981:diagnostic imaging* / Q000601:surgery*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000000981:diagnostic imaging* / Q000601:surgery*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives