Equivalence between evlt and hls for varicose vein treatment


Equivalence between evlt and hls for varicose vein treatment


A report published Online First by Archives of Dermatology, one of the JAMA/Archives journals indicates that endovenous laser treatment (EVLT) as well as high ligation and stripping (HLS) are both linked to effective and safe treatment of insufficiency of the great saphenous vein (GSV), but EVLT is more frequently linked to recurrences. According to background information in the article as many as 28 to 35 percent of adults suffer from chronic venous insufficiency caused by varicose veins. Treatments may help to reduce symptoms, avoid long-term complications and improve disease-related quality of life (QOL).

The GSV originates from where the dorsal vein of the first digit (the large toe) merges with the dorsal venous arch of the foot and after passing anterior to the medial malleolus, it runs up the medial side of the leg. The standard treatment for insufficiently working GSVs is removal of the vein but recurrence rates may be 30 to 40 percent at five years and are often caused because of neovascularization (growth of new blood vessels). Endovenous laser treatment (EVLT) offers a common alternative treatment to eradicate varicose veins. The treatment involves inserting a catheter into the vein and eroding the varicose vein with laser energy. The authors comment that because only few published randomized, controlled trials (RCTs) exist of these techniques, "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., from the Saarland University Hospital in Homburg, Germany, and his team carried out a randomized, controlled trial, in which ambulatory and hospitalized participating patients with GSV insufficiency were assigned to two vein centers in Germany: a university dermatology department performed the EVLT on 185 patients' limbs and a specialized vein clinic performing HLS on 161 patients' limbs.

The study period started in September 2004 and ended in March 2007 with a follow-up of two years.

Outcomes included clinical recurrence, especially of the saphenofemoral vein; severity of the condition; hemodynamics (blood flow in the vein), QOL, adverse effects and evaluation of patients' and surgeons' satisfaction.

Both groups developed similar rates of clinically recurrent varicose veins after treatment, i.e. 16.2 % treated with EVLT compared with 23.1% treated with HLS. In comparison to the HLS group, the EVLT group showed significantly more frequent saphenofemoral refluxes detected by duplex ultrasonography, while scores on disease severity and disease-related QOL measures improved equally in both groups. Endovenous laser treatment was linked to more adverse effects and also greater improvements in hemodynamics, recovery and cosmetic outcome.The study seemed to indicate equivalence between EVLT and HLS for the primary objective of clinical recurrence and most of the secondary objectives at the two-year follow-up. According to the authors, all patients were extremely satisfied with the treatment results of both procedures, with 98% of participants stating that they would undergo each treatment again.

In a concluding statement, the researchers highlight the different rates of saphenofemoral vein recurrence and call for more studies, saying: "The significantly higher rate and the course of duplex-detected saphenofemoral recurrences after EVLT will remain a matter of further investigations."


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