Abstract
Background
Endovenous laser ablation (EVLA) is a minimally invasive technique for treating varicose veins due to truncal vein incompetence. This randomized trial compared EVLA with conventional surgery in patients with primary saphenofemoral and great saphenous vein (GSV) reflux.
Methods
Consecutive consenting patients with symptomatic varicose veins were randomized to EVLA 1 (stepwise laser withdrawal), EVLA 2 (continuous laser withdrawal) or surgery (saphenofemoral ligation, GSV stripping, multiple phlebectomies). Principal outcome measures were abolition of GSV reflux and improvement in Aberdeen Varicose Vein Symptom Score (AVVSS) 3 months after treatment.
Results
GSV reflux was abolished in 41 of 42 legs treated with EVLA 1, 26 of 29 following EVLA 2 and 28 of 32 after surgery (P = 0ยท227). The median (interquartile range, i.q.r.) AVVSS improvement was similar: 9ยท38 (4ยท54โ14ยท93) with EVLA 1, 10ยท26 (5ยท03โ15ยท03) after EVLA 2 and 8ยท36 (4ยท54โ13ยท21) following surgery (P = 0ยท694). Return to normal activity (median (i.q.r.) 2 (0โ7) versus 7 (2โ26) days; P = 0ยท001) and work (4 (2โ7) versus 17 (7ยท25โ33ยท25) days; P = 0ยท005) was quicker after EVLA by either method.
Conclusion
Abolition of reflux and improvement in disease-specific quality of life was comparable following both EVLA and surgery. The earlier return to normal activity following EVLA may confer important socioeconomic advantages. Registration number: ISRCTN99270116 (http://www.controlled-trials.com).