To evaluate the efficiency and safety of endovenous laser ablation (EVLA) for primary lower extremity varicosities compared with high ligation and stripping (HLS).
Method:
Prospective non-randomized studies and randomized control trials on comparison of EVLA and HLS in treating varicose vein were included in this study. A meta-analysis on the data of suitable 13 clinical trials was performed using the Mantel–Haenszel method and the risk ratio was calculated. Thirteen studies including a total of 2245 limbs were eligible for inclusion. Among them, 1128 limbs were treated with endovenous laser ablation, whereas 1117 were treated with high ligation and stripping. Primary outcome measures were technical success rates and recurrence rates at different follow-up duration and complication rates.
Results:
No significant difference in initial technical success rates, Procedural failures were more common following EVLA compared with conventional surgery at one- and two-year follow-up. However, the duplex-detected and clinical recurrence rate was similar between conventional surgery and EVLA after one and two years. No statistical significance was found in postoperative phlebitis and bruise in EVLA and HLS (17.9% versus 21.5%). However, fewer complications were observed in EVLA compared with HLS, including bleeding and haematoma (1.28% versus 4.83%), wound infection (0.33% versus 1.91%) and paraesthesia (6.73% versus 11.27%).
Conclusions:
EVLA for varicose veins is safe and effective compared with HLS in a two-year range. More randomized controlled studies follow-up results are needed to clarify longterm recurrence (5 years).
EvansCJ, FowkesFGR, RuckleyCV, LeeAJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study.J Epidemiol Community Health1999; 53: 149–53.
2.
RabeE, Pannier-FischerF, BromenK. Bonn Vein Study by the German Society of Phlebology: epidemiological study to investigate the prevalence and severity of chronic venous disorders in the urban and rural residential populations.Phlebologie2003; 32: 1–14.
3.
BealeRJ, GoughMJ. Treatment options for primary varicose veins: a review.Eur J Vasc Endovasc Surg2005; 30: 83–95.
4.
JonesL, BraithwaiteBD, SelwynD, CookeS, EarnshawJJ. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomised trial of stripping the long saphenous vein.Eur J Vasc Endovasc Surg1996; 12: 442–5.
5.
FischerR, ChandlerJG, De MaeseneerMG. The unresolved problem of recurrent saphenofemoral reflux.J Am Coll Surg2002; 195: 80–94.
6.
Van RijAM, JonesGT, HillGB, JiangP. Neovascularization and recurrent varicose veins: more histologic and ultrasound evidence.J Vasc Surg2004; 40: 296–302.
7.
FassiadisN, KianifardB, HoldstockJM, WhiteleyMS. Ultrasound changes at the saphenofemoral junction and in the long saphenous vein during the first year after VNUS Closure.Int Angiol2002; 21: 272–74.
8.
DisselhoffBC, der KinderenDJ, KelderJC, MollFL. Five-year results of a randomised clinical trial of endovenous laser ablation of the great saphenous vein with and without ligation of the saphenofemoral junction.Eur J Vasc Endovasc Surg2011; 41: 685–90.
9.
NavarroL, MinRJ, BoneC. Endovenous laser: a new minimally invasive method of treatment for varicose veins - preliminary observations using an 810 nm diode laser.Dermatol Surg2001; 27: 117–22.
10.
AgusGB, ManciniS, MagiG, IEWG. The first 1000 cases of Italian Endovenous-EVL Working Group (IEWG). Rationale, and longterm outcomes for the 1999-2003 period.Int Angiol2006; 25: 209–15.
11.
MorrisonN. Saphenous ablation: what are the choices, EVL or RF energy.Semin Vasc Surg2005; 18: 15–8.
TheivacumarNS, DellagrammaticasD, BealeRJ, MavorAID, GoughMJ. Fate and clinical significance of saphenofemoral junction tributaries following endovenous laser ablation of great saphenous vein.Br J Surg2007; 94: 722–5.
14.
AgusGB, ManciniS, MagiG. The first 1000 cases of Italian Endovenous-laser Working Group (IEWG). Rationale, and longterm outcomes for the 1999-2003 period.Int Angiol2006; 25: 209–15.
15.
RaviR, RodriguezLJ, TraylerEA, BarrettDA, RamaiahV, DiethrichE. Endovenous ablation of incompetent saphenous veins: a large single-center experience.J Endovasc Ther2006; 13: 244–8.
ProebstleTM, LehrHA, KarglA. Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles.J Vasc Surg2002; 35: 729–36.
18.
VuylstekeM, Van Den BusscheD, AudenaertEA, LissensP. Endovenous laser obliteration for the treatment of primary varicose veins.Phlebology2006; 21: 80–7.
19.
MekakoAI, HatfieldJ, BryceJ. A nonrandomised controlled trial of endovenous laser therapy and surgery in the treatment of varicose veins.Ann Vasc Surg2006; 20: 451–7.
20.
TheivacumarNS, DarwoodR, GoughMJ. Neovascularisation and recurrence 2 years after varicose vein treatment for saphenofemoral and great saphenous vein reflux: a comparison of surgery and endovenous laser ablation.Eur J Vasc Endovasc Surg2009; 38: 203–7.
21.
de MedeirosCAF, LuccasGC. Comparison of endovenous treatment with an 810 nm laser versus conventional stripping of the great saphenous vein in patients with primary varicose veins.Dermatol Surg2005; 31: 1685–94; discussion 1694
22.
DarwoodRJ, TheivacumarN, DellagrammaticasD, MavorAI, GoughMJ. Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins.Br J Surg2008; 95: 294–301.
23.
KalteisM, BergerI, Messie-WerndlS. High ligation combined with stripping and endovenous laser ablation of the great saphenous vein: early results of a randomized controlled study.J Vasc Surg2008; 47: 822–9; discussion 829
24.
RasmussenLH, BjoernL, LawaetzM. 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 Vasc Surg2007; 46: 308–15.
25.
RasmussenLH, BjoernL, LawaetzM, LawaetzB, BlemingsA, EklöfB. Randomised clinical trial comparing endovenous laser ablation with stripping of the great saphenous vein: clinical outcome and recurrence after 2 years.Eur J Vasc Endovasc Surg2010; 39: 630–5.
26.
ChristensonJT, GueddiS, GemayelG, BounameauxH. Prospective randomized trial comparing endovenous laser ablation and surgery for treatment of primary great saphenous varicose veins with a 2-year follow-up.J Vasc Surg2010; 52: 1234–41.
27.
PronkP, GauwSA, MooijMC. Randomised controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anaesthesia: one year results.Eur J Vasc Endovasc Surg2010; 40: 649–56.
28.
CarradiceD, MekakoAI, MazariFA, SamuelN, HatfieldJ, ChetterIC. Randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins.Br J Surg2011; 98: 501–10.
29.
CarradiceD, MekakoAI, MazariFA, SamuelN, HatfieldJ, ChetterIC. Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins.Br J Surg2011; 98: 1117–23.
30.
RassK, FringsN, GlowackiP. Comparable effectiveness of endovenous laser ablation and high ligation with stripping of the great saphenous vein: two-year results of a randomized clinical trial (RELACS study).Arch Dermatol2012; 148: 49–58.
31.
RasmussenLH, LawaetzM, BjoernL, VennitsB, BlemingsA, EklofB. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins.Br J Surg2011; 98: 1079–87.
32.
DisselhoffBC, der KinderenDJ, KelderJC, MollFL. Randomized clinical trial comparing endovenous laser with cryostripping for great saphenous varicose veins.Br J Surg2008; 95: 1232–8.
33.
DisselhoffBC, der KinderenDJ, KelderJC, MollFL. Five-year results of a randomized clinical trial comparing endovenous laser ablation with cryostripping for great saphenous varicose veins.Br J Surg2011; 98: 1107–11.
34.
RasmussenL. Laser treatment as an alternative for the treatment of GSV and SSV incompetence, In: WittensC, ed. Innovative Treatment of Venous Disorders.EVC Edizioni Minerva Medica Turin, 2009
35.
De MaeseneerMG, VandenbroeckCP, HendriksJM, LauwersPR, Van SchilPE. Accuracy of duplex evaluation one year after varicose vein surgery to predict recurrence at the saphenofemoral junction after five years.Eur J Vasc Endovasc Surg2005; 29: 308–15.
36.
EganB, DonnellyM, BresnihanM, TierneyS, FeeleyM. Neovascularization: an “innocent bystander” in recurrent varicose veins.J Vasc Surg2006; 44: 1279–84.
37.
PerrinMR, LabropoulosN, LeonLRJr. Presentation of the patient with recurrent varices after surgery (REVAS).J Vasc Surg2006; 43: 327–34.
38.
FringsN, NelleA, TranPh, FischerR, KrugW. Reduction of neoreflux after correctly performed ligation of saphenofemoral junction. A randomised trial.Eur J Vasc Endovasc Surg2004; 28: 246–52.
39.
CampagnoloP, CesselliD, Al Haj ZenA. Human adult vena saphena contains perivascular progenitor cells endowed with clonogenic and proangiogenic potential.Circulation2010; 121: 1735–45.
40.
TheivacumarNS, BealeRJ, DellagrammaticasD, MavorAI, GoughMJ. Factors influencing the effectiveness of endovenous laser ablation (EVLA) in the treatment of great saphenous vein reflux.Eur J Vasc Endovasc Surg2008; 35: 119–23.
41.
SchmedtCG, MeissnerOA, HungerK. Evaluation of endovenous radiofrequency ablation and laser therapy with endoluminal optical coherence tomography in an ex vivo model.J Vasc Surg2007; 45: 1047–58.
42.
KabnickLS. Outcome of different endovenous wavelengths for great saphenous vein ablation.J Vasc Surg2006; 43: 88–93.
43.
ProebstleTM, MoehlerT, GulD, HerdemannS. Endovenous treatment of the great saphenous vein using a 1,320 nm Nd:YAG laser causes fewer side effects than using a 940 nm diode laser.Dermatol Surg2005; 31: 1678–83.
44.
NisarA, ShabbirJ, TubassamMA. Local anaesthetic flush reduces postoperative pain and haematoma formation after great saphenous vein strippingea randomised controlled trial.Eur J Vasc Endovasc Surg2006; 31: 325–31.
45.
van den BosR, ArendsL, KockaertM, NeumannM, NijstenT. Endovenous therapies of lower extremity varicosities: a meta-analysis.J Vasc Surg2009; 49: 230–9. Epub 2008 Aug 9
