HLS (High ligation and stripping) and EVLT (endovenous laser treatment) have similar efficacy and safety rates in the treatment of insufficiency of the great saphenous vein (GSV), but there are slightly less cases of recurrences after EVLT than HLS, researchers from Saarland University Hospital, Homburg, Germany, reported in Archive of Dermatology.
Between 28% and 35% of adults have chronic venous insufficiency caused by varicose veins, the authors explained. Treatments for chronic venous insufficiency may prevent long-term complications as well as alleviating symptoms, resulting in improved disease related QOL (quality of life).
The great saphenous vein, also known as the greater saphenous vein or the large saphenous vein is the larger of the two saphenous veins, the main veins that run up the leg, near the surface. It goes from the foot right up to the saphenous opening in the broad fascia of the thigh. Like other superficial veins (veins near the surface of the skin), the great saphenous vein can develop varices, which are usually considered unsightly. Although varicose veins are not life-threatening, people often seek treatment to have them removed.
For GSV insufficiency, the standard treatment is HLS – removal of the vein. Recurrence rates (of varicose veins) may be as high as 30% to 40% because new blood vessels grow. EVLT, a common alternative to HLS, involves inserting a catheter into the vein and ablating it with laser energy.
There are very few randomized, controlled human studies which compare EVLT to HLS, the authors explain. Therefore, “there is still a medical need for further RCTs comparing endovenous techniques with standard surgical treatment of saphenous vein incompetence to drive reliable conclusions, particularly concerning clinical efficacy.”
Knuth Rass, M.D., and team carried out a randomized, controlled trial with a two-year follow-up. Participants were randomly assigned to two vein centers in Germany. 185 patients’ limbs received EVLT at a university dermatology department, while a specialized vein clinic carried out HLS on 161 patients’ limbs. The researchers gathered data on recurrence, especially of the saphenofemoral vein, condition severity, blood flow in the vein (hemodynamics), quality of life, adverse effects and surgeons’ and patients’ satisfaction evaluations.
16.2% of those treated with EVLT had recurrent varicose veins, compared to 23.1% of those treated with HLS – the authors described the rates as similar. Saphenofemoral refluxes were more common among the EVLT groups (17.8%) than the HLS group (1.3%), according to duplex ultrasonography scans. Both groups had the same disease-related QOL improvement measures. Even though EVLT was linked to more side effects, it was also associated with greater improvements in cosmetic outcome, recovery and hemodynamics. The authors noted:
“The patients were remarkably satisfied with the treatment results of both procedures. Ninety-eight percent of the study population would undergo each treatment once again. The significantly higher rate and the course of duplex-detected saphenofemoral recurrences after EVLT will remain a matter of further investigations.”
Written by Christian Nordqvist