Endovenous laser treatment versus surgery for incompetent greater saphenous veins – a prospective study
This study was designed to evaluate the efficacy of the new endovascular laser treatment compared with the old surgical method.
We randomized a total of 646 patients with incompetent greater saphenous veins in two groups, 314 with endovenous laser treatments, and 332 with crosectomies and saphenectomies. The patients were submitted to a complete phlebological examination, including Echo Doppler and were informed about both methods. The selection was based on the payment possibility of the patients, with laser treatment being considerably more expansive and not accessible to almost half of patients. All the operations were performed under local anaesthesia, ambulatory – endovenous laser treatment +/- phlebectomies and crossectomy and saphenectomy. The patients were monitorised clinically and by Echo Doppler at 7 days, one month, 3 months, 6 months, 1 year, and every 6 months after.
Clinical recurrence at 4 years was 3% for the laser group and 4% for the surgical group. The morbidity was very low for the laser group – 4%, indurations, pain and inflammation on the route of the vein, and very small echymosis, without superficial burns, hematomes or deep vein thrombosis. The recovery for work was 2-3 days.
For the surgical group, the morbidity was around 10% – hematomas, paresthesias, infection of the wound, deep vein thrombosis (1case) and a lot of cases with echymoses and pain. The patients recovered for work at 5-7 days.
The endovascular laser treatment brings less complications than surgery and less days of recovery. We still need more time to evaluate the situation, but for us is it clear that the future is not the surgery in the varicose veins disease.
Stefan Jianu, Eduard Ursuleanu, surgery, ProEstetica Medical Center, Bucharest, Romania