Endovenous laser ablation (EVLA) versus high ligation and striping (HL/S): Two-years follow up

Yıl 2012, Cilt: 17 Sayı: 2, 83 - 87, 23.01.2013

Halil Basel Cemalettin Aydin Yasin Ay Bekir İnan Hasan Ekim Cemil Goya Mehmet Bilgin

Öz

Abstract. Endovenous laser ablation (EVLA) of the great saphenous vein (GSV) is thought to minimize postoperative morbidity and reduce work loss compared with high ligation and stripping (HL/S). However, the procedures have not previously been compared in a trial with parallel groups where both treatments were performed in tumescent anesthesia on an out-patient basis. Patients with varicose veins due to GSV insufficiency were randomized to either EVLA (980 nm) or HL/S in tumescent anesthesia. Miniphlebectomies were also performed. In our clinics, 87 varicosis patients were treated between September 2006 and December 2009. EVLA was applied in 90 cases and HL/S was applied in 84 cases. Clinical features and demographic characteristics of the patients were summarized. EVLA procedure was done by 980 nm diode laser (Ceralas D 980, Biolitec) at continues mode with 15 W energy.  Patient visits were done at post-operative 10th day, 6th month, 1st year and 2nd year. Routine physical examination and Doppler USG assessments were performed at these visits. EVLA and HL/S procedures were done in complete success in all cases at both groups.  All cases were invited for control visits. At post-operative 10th day all patients were evaluated, at 1st year control visit number of attended patients was 130 (EVLA: 68, HL/S: 62) and at 2nd year control, visit number of attended patients was 104 (EVLA: 56, HL/S: 48). When complications developed after procedures were evaluated; no infection, hematoma or paresthesis were observed in EVLA group. However in HL/S group; infections, hematomas and paresthesis were observed in 2, 6 and 24 cases respectively.  In terms of treatment success there was not significant difference between EVLA procedure and HL/S methods. However, in terms of post-op complication, EVLA method was associated with significantly less paresthesis, hematoma and pain. EVLA method is a method as effective and safe as standard treatment. However, when a long term result of this method is shown completely, its effectiveness will be cleared and its clinical utility will be established.

Key words: Endovenous laser ablation, great saphenous vein, high ligation and stripping

Anahtar Kelimeler

Endovenous laser ablation, great saphenous vein, high ligation and stripping

Kaynakça

• Callam M.J. Epidemiology of varicose veins Br J Surg 1994; 81: 167-173.
• Slagsvold CE, Stranden E, Rosales A. Venous insufficiency in the lower limbs Tidsskr Nor Laegeforen. 2009 Nov 5; 129: 2256-2259.
• Evans CJ, Fowkes FG, Ruckley CV,et al. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health 1999; 53: 149-153.
• Carpentier PH, Maricq HR, Biro C, et al. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France J Vasc Surg 2004; 40: 650-659.
• Jawien A. The influence of environmental factors in chronic venous insufficiency. Angiology 2003; 54 1: 19-31.
• National Institute for Clinical Excellence-NICE. Interventional procedures overview of endovenous laser treatment of the long saphenous vein 2003.
• Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. J VascIntervRadiol 2003; 14: 991-996.
• Teruya TH, Ballard JL. New approaches for the treatment of varicose veins. Surg Clin North Am 2004; 84: 1397-417.
• Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg 2001; 27: 58-60.
• Lurie F, Creton D, Eklof B, et al. Prospective randomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation and stripping in a selected patient population 2003; 38: 207-214.
• Lurie F, Creton D, Eklof B, et al. Prospective randomised study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS): two-year follow-up. Eur J Vasc Endovasc Surg 2005; 29: 67-73.
• Hinchliffe RJ, Ubhi J, Beech A, et al. Braithwaite BDA prospective randomised controlled trial of VNUS closure versus surgery for the treatment of recurrent long saphenous varicose veins. Eur J VascEndovascSurg 2006; 31: 212-218.
• De Medeiros CAF, Luccas GC. Comparison of endovenous treatment with an 810 nm laser versus conventional stripping of the GSV in patients with primary varicose veins. DermatolSurg 2005; 31: 1685-1694.
• Wright D, Gobin JP, Bradbury AW, et al. Varisolve® polidocanolmicrofoam compared with surgery or sclerotherapy in the management of varicose veins in the presence of trunk vein incompetence: European randomized controlled trial. Phlebology 2006; 21: 180-190.
• Hartmann K, Klo de J, Pfister R, et al. Recurrent varicose veins: sonography-based re-examination of 210 patients 14 years after ligation and saphenous vein stripping. Vasa 2006; 35: 21-26.
• Uncu H. Should complete stripping operation to the ankle be avoided in the treatment of primary varicose veins due to greater saphenous vein insufficiency? Acta Cir Bras 2009; 24: 411-415.
• Rasmussen LH, Bjoern L, Lawaetz M, et al. Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: short-term results. J VascSurg 2007; 46: 308-315.
• Proebstle T, Gül D, Lehr H, et al. Infrequent early recanalization of greater saphenous vein after endovenous laser treatment. Journal of Vascular 2003; 38: 511-516.
• Al Samaraee A, McCallum IJ, Mudawi A. Endovenous therapy of varicose veins: A better outcome than standard surgery? Surgeon 2009; 3: 181-186.
• Theivacumar NS, Della grammaticas D, Beale RJ, et al. Fate and clinical significance of saphenofemoral junction tributaries following endovenous laser ablation of great saphenous vein. Br J Surg 2007; 94: 722-725.
• Demirkılıç U. Endovenöz Lazer Tedavisinde Son Gelişmeler Turkiye Klinikleri J Cardiovasc Surg- Special Topics 2009; 2: 36-38.
• Prince EA, Ahn SH, Dubel GJ, et al. An investigation of the relationship between energy density and endovenous laser ablation success: does energy density matter?J Vasc Interv Radiol 2008; 19: 1449- 1453.