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. Method: 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%); 2 ‫؍‬ 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. ( J Vasc Surg 2008;48:173-8.)

Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation

“…In fact, only that of Michaels et al 2 falls within the IQR of the national reference costs (£765-1355). 52 The study characteristics shown in Table 25 do not explain these variations. All the studies compared different treatments with stripping, so their costs relative to stripping can be calculated.…”

“…Of the total 36,000 varicose vein procedures captured in the 2009/10 national reference costs, almost 80% were conducted as day cases, the majority of which were a primary unilateral procedure without complications (84%). 52 The average cost of such procedures, inflated to 2011/12 with an inflation factor of 1.064, 144 is £1155 (IQR £765-1355). 52 The Table 25 includes one further UK cost study which was identified in a later search (see below).…”

“…52 The average cost of such procedures, inflated to 2011/12 with an inflation factor of 1.064, 144 is £1155 (IQR £765-1355). 52 The Table 25 includes one further UK cost study which was identified in a later search (see below).…”

“…All the studies compared different treatments with stripping, so their costs relative to stripping can be calculated. Table 28 shows the estimated costs of varicose vein procedures, assuming the cost of stripping is the national reference cost for primary unilateral day-case procedures, 52 and the relative costs for other procedures based on the data from the RCTs shown in Table 27. The validity of the assumption that the national reference cost for all procedures was reasonably representative of the costs of stripping, although accounting for only 52% of activity, was explored using the limited HES activity data (see Table 1) and the cost ratios shown in Table 28.…”

Laser saphenous ablation results with at least one year of follow-up

“…19 Incidence of hypoaesthesia, swelling, bruising and discomfort following EVLA are not rare, but these impairments are usually self-limited and often improve within months. 10,20 Hyperpigmentation along the course of the treated vein can also be seen at times, especially if the vein is above the fascial level and in thin individuals, but this complication also gradually fades over time. 10 The mean body mass index for our patients with hyperpigmentation following EVLA was significantly low and they were thin individuals.…”