title: Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia.
abstract: OBJECTIVE
  The objective of this study was to compare the long-term results (groin-related recurrence, great saphenous vein [GSV] occlusion rate, Clinical class, Etiology, Anatomy, and Pathophysiology [CEAP] staging, and quality of life [QoL]) after the treatment of a GSV incompetence by saphenofemoral ligation and stripping (SFL/S) with endovenous laser ablation bare fiber, 980 nm (EVLA).
  
  
  METHODS
  Patients with GSV insufficiency and varicose veins were randomized to either undergo SFL/S or EVLA, both of which were performed under tumescent anesthesia. The long-term results, which included the anatomic occlusion rate, varicose vein recurrence at the saphenofemoral junction (SFJ), relief of venous symptoms and QoL, were compared up to 5 years after treatment.
  
  
  RESULTS
  A total of 130 legs of 121 patients were treated with either SFL/S (n = 68) or EVLA (n = 62). In the first 12 months, three recanalizations of the GSV were observed after EVLA. Up to 5 years later, more recurrent varicose veins caused by neoreflux in incompetent tributaries of the SFJ were observed in after EVLA (31%; 19/61) compared with SFL/S (7%; 4/60; P < .01). Neovascularization in the groin with clinically visible recurrence identified at 3 and 5 years post-treatment follow-up was only observed in the SFL/S group (n = 6). After 5 years, clinically visible recurrences originating from the SFJ region after EVLA were observed 33% (20/61) compared with 17% of patients (10/60) after SFL/S (P < .04). In both treatment groups, venous symptoms improved significantly. Patients in both groups reported a continuing significant cosmetic improvement measured on a visual analog scale of 1 to 10 (mean, 7.49; P < .01). There was no difference in the CEAP staging and a standardized, non-disease-specific instrument for describing and valuing health states (EuroQol-5D), between the groups up to 5 years after follow-up.
  
  
  CONCLUSIONS
  At the 5-year follow-up, a significantly higher varicose vein recurrence rate originated at the SFJ region after EVLA compared with SFL/S. There were no differences in the relief of venous symptoms, CEAP staging, or general QoL between the groups.
authors.affiliation: Centrum Oosterwal, Alkmaar, The Netherlands. Electronic address: s.gauw@centrum-oosterwal.nl.
authors.forename: Stefanie A
authors.initials: SA
authors.lastname: Gauw
authors.affiliation: Centrum Oosterwal, Alkmaar, The Netherlands.
authors.forename: James A
authors.initials: JA
authors.lastname: Lawson
authors.affiliation: Centrum Oosterwal, Alkmaar, The Netherlands.
authors.forename: Clarissa J
authors.initials: CJ
authors.lastname: van Vlijmen-van Keulen
authors.affiliation: Centrum Oosterwal, Alkmaar, The Netherlands.
authors.forename: Pascal
authors.initials: P
authors.lastname: Pronk
authors.affiliation: Centrum Oosterwal, Alkmaar, The Netherlands.
authors.forename: Menno T W
authors.initials: MT
authors.lastname: Gaastra
authors.affiliation: Centrum Oosterwal, Alkmaar, The Netherlands.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Mooij
mesh_terms: D000328:Adult; D000772:Anesthesia, Local; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation; D008026:Ligation; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; 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 / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D014689:Venous Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*