Minimally Invasive Treatment for Varicose Veins: A Review of Endovenous Laser Treatment and Radiofrequency Ablation

Beale, R.J.; Mavor, A. I. D.; Gough, Michael

doi:10.1177/1534734604272245

Cited by 21 publications

(18 citation statements)

References 31 publications

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“…Most studies describing EVLA had used either 810-or 940-nm diode lasers based on a haemoglobin absorption peak to red/infrared light of 800-1000 nm. 22 The heat generated by the laser was believed to result in thermal damage to the endothelium and subendothelial layer, resulting in focal coagulative necrosis and shrinkage and leading to thrombotic occlusion of the vein. 23 However, histological studies at 3 and 6 months following EVLA indicate failure of endothelial regeneration and progressive damage to the muscle layers of the vein wall, resulting in further shrinkage and occlusion.…”

Section: Endovenous Laser Ablationmentioning

confidence: 99%

“…24 Studies had shown that between 30% and 99% of patients receiving EVLA require subsequent treatment for non-trunk varicosities. 22 It had been shown that successful occlusion was dependent on the energy used and could be achieved in all veins treated with ≥ 70 J/cm. 25 A RCT carried out by one of the CLASS co-investigators reported on 118 patients randomised to EVLA or surgery.…”

Section: Endovenous Laser Ablationmentioning

confidence: 99%

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Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of LAser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial

Brittenden

Cotton

Elders

et al. 2015

Health Technology Assessment

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BackgroundFoam sclerotherapy (foam) and endovenous laser ablation (EVLA) have emerged as alternative treatments to surgery for patients with varicose veins, but uncertainty exists regarding their effectiveness in the medium to longer term.ObjectivesTo assess the clinical effectiveness and cost-effectiveness of foam, EVLA and surgery for the treatment of varicose veins.DesignA parallel-group randomised controlled trial (RCT) without blinding, and economic modelling evaluation.SettingEleven UK specialist vascular centres.ParticipantsSeven hundred and ninety-eight patients with primary varicose veins (foam,n = 292; surgery,n = 294; EVLA,n = 212).InterventionsPatients were randomised between all three treatment options (eight centres) or between foam and surgery (three centres).Primary outcome measuresDisease-specific [Aberdeen Varicose Vein Questionnaire (AVVQ)] and generic [European Quality of Life-5 Dimensions (EQ-5D), Short Form questionnaire-36 items (SF-36) physical and mental component scores] quality of life (QoL) at 6 months. Cost-effectiveness as cost per quality-adjusted life-year (QALY) gained.Secondary outcome measuresQuality of life at 6 weeks; residual varicose veins; Venous Clinical Severity Score (VCSS); complication rates; return to normal activity; truncal vein ablation rates; and costs.ResultsThe results appear generalisable in that participants’ baseline characteristics (apart from a lower-than-expected proportion of females) and post-treatment improvement in outcomes were comparable with those in other RCTs. The health gain achieved in the AVVQ with foam was significantly lower than with surgery at 6 months [effect size −1.74, 95% confidence interval (CI) −2.97 to −0.50;p = 0.006], but was similar to that achieved with EVLA. The health gain in SF-36 mental component score for foam was worse than that for EVLA (effect size 1.54, 95% CI 0.01 to 3.06;p = 0.048) but similar to that for surgery. There were no differences in EQ-5D or SF-36 component scores in the surgery versus foam or surgery versus EVLA comparisons at 6 months.The trial-based cost-effectiveness analysis showed that, at 6 months, foam had the highest probability of being considered cost-effective at a ceiling willingness-to-pay ratio of £20,000 per QALY. EVLA was found to cost £26,107 per QALY gained versus foam, and was less costly and generated slightly more QALYs than surgery. Markov modelling using trial costs and the limited recurrence data available suggested that, at 5 years, EVLA had the highest probability (≈ 79%) of being cost-effective at conventional thresholds, followed by foam (≈ 17%) and surgery (≈ 5%).With regard to secondary outcomes, health gains at 6 weeks (p < 0.005) were greater for EVLA than for foam (EQ-5D,p = 0.004). There were fewer procedural complications in the EVLA group (1%) than after foam (7%) and surgery (8%) (p < 0.001). Participants returned to a wide range of behaviours more quickly following foam or EVLA than following surgery (p < 0.05). There were no differences in VCSS between the three treatments. Truncal ablation rates were higher for surgery (p < 0.001) and EVLA (p < 0.001) than for foam, and were similar for surgery and EVLA.ConclusionsConsiderations of both the 6-month clinical outcomes and the estimated 5-year cost-effectiveness suggest that EVLA should be considered as the treatment of choice for suitable patients.Future workFive-year trial results are currently being evaluated to compare the cost-effectiveness of foam, surgery and EVLA, and to determine the recurrence rates following each treatment. This trial has highlighted the need for long-term outcome data from RCTs on QoL, recurrence rates and costs for foam sclerotherapy and other endovenous techniques compared against each other and against surgery.Trial registrationCurrent Controlled Trials ISRCTN51995477.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 27. See the NIHR Journals Library website for further project information.

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Section: Endovenous Laser Ablationmentioning

confidence: 99%

Section: Endovenous Laser Ablationmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of LAser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial

Brittenden

Cotton

Elders

et al. 2015

Health Technology Assessment

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“…Endovenous laser treatment (ELT) is one of the most promising of these new techniques [2][3][4]. In 1999, Boné [5] first reported the delivery of endoluminal laser energy.…”

Section: Introductionmentioning

confidence: 99%

Mathematical modeling of 980‐nm and 1320‐nm endovenous laser treatment

Mordon

Wassmer²,

Zemmouri³

2007

Lasers Surg Med

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Numerical simulations are in agreement with LEED reported in clinical studies. Mathematical modeling shows clearly that 1,320 nm, with a better absorption by the vessel wall, requires less energy to achieve wall damage. In the 810-1,320-nm range, blood plays only a minor role. Consequently, the classification of these lasers into hemoglobin-specific laser wavelengths (810, 940, 980 nm) and water-specific laser wavelengths (1,320 nm) is inappropriate. In terms of closure rate, 980 nm and 1,320 nm can lead to similar results and, as reported by the literature, to similar side effects. This model should serve as a useful tool to simulate and better understand the mechanism of action of the ELT.

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“…However, the percutaneous treatments described here are gaining momentum as a less invasive alternative when compared to SEPS. These treatments offer several advantages in that they can be applied with local anesthesia or oral/IV sedation, and distal perforators around the malleolus are easily treatable unlike SEPS (24,32,44). These treatments are performed without incisions, and are easily repeatable if necessary.…”

Section: Evtamentioning

confidence: 99%

“…Local side effects include ecchymosis, induration or paraesthesia. Rare systemic complications include DVT and pulmonary emboli (6,32,33). For laser energy, commercially available 940-nm diode, 1,320 nm Nd:YAG and 1,470-nm microfibers can be used for perforator vein ablation (34)(35)(36)(37).…”

Section: Evtamentioning

confidence: 99%