Lasers in Medical Science

, Volume 29, Issue 2, pp 765–771 | Cite as

Endovenous laser ablation of the great saphenous vein versus high ligation: long-term results

  • Mohammad Mozafar
  • Khashayar Atqiaee
  • Hamidreza Haghighatkhah
  • Morteza Sanei Taheri
  • Ali Tabatabaey
  • Saran Lotfollahzadeh
Original Article

Abstract

Endovenous laser therapy (EVLT) for greater saphenous vein (GSV) insufficiency is a relatively new method of treatment only recently made available in Iran. This is the first long-term randomized trial comparing EVLT with high ligation of saphenous vein (HLS) in the Iranian population. Sixty-five patients met the inclusion criteria and were divided into homogenous treatment groups of EVLT (n = 30) or HLS (n = 35). Clinical severity, etiology, anatomy, pathophysiology (CEAP) classification and Aberdeen Varicose Vein Symptom Severity Scores (AVSS) were used to determine disease severity and symptoms before and after the procedure in both groups. Outcome was measured by the rate of recurrence as shown in Doppler ultrasonography evaluation. Follow-up was conducted 1 week and 3, 6, 12, and 18 months after the intervention. The occlusion rate of GSV was similar in both groups (93.6 % for EVLT, 88.3 for HLS) at 18 months of follow-up. The median CEAP score showed a dramatic decrease in both groups after 1 week which was sustained for the rest of the study. The Aberdeen Varicose Vein Symptom Severity score was significantly lower in the EVLT group at 12 and 18 months of follow-up. There was no significant difference in patient satisfaction in both groups. Our findings show that EVLT may offer a better long-term relief of symptoms. This, alongside its better cosmetic outcome, and less invasive anesthesia requirements may make it the favorable choice for treatment of GSV insufficiency.

Keywords

Laser therapy Saphenous veins Venous insufficiencies 

References

  1. 1.
    Bartholomew JR, King T, Sahgal A, Vidimos AT (2005) Varicose veins: newer, better treatments available. Cleve Clin J Med 72(4):312–4, 9–21, 25–28PubMedCrossRefGoogle Scholar
  2. 2.
    Teo TK, Tay KH, Lin SE, Tan SG, Lo RH, Taneja M et al (2010) Endovenous laser therapy in the treatment of lower-limb venous ulcers. J Vasc Interv Radiol 21(5):657–662PubMedCrossRefGoogle Scholar
  3. 3.
    Massarrat M-S, Tahaghoghi-Mehrizi S (2002) Iranian National Health Survey: a brief report. Arch Iranian Med 5(2):73–79Google Scholar
  4. 4.
    Robertson L, Evans C, Fowkes FG (2008) Epidemiology of chronic venous disease. Phlebology 23(3):103–111PubMedCrossRefGoogle Scholar
  5. 5.
    SharifNia H, Haghdoost AA, Beheshti Z, Ghorbani M, Mahbobi M (2010) Investigating the relationship between demographic and occupational factors with the intensity of nurse legs varicose veins in Amol hospitals. Iran Occup Health 7(1):11–17Google Scholar
  6. 6.
    Parvizpour D (1982) Varicose veins in male weavers; an epidemiological study. Iran J Publ Health 11(3, 4):63–69Google Scholar
  7. 7.
    Labas P, Cambal M (2007) Profuse bleeding in patients with chronic venous insufficiency. Int Angiol 26(1):64–66PubMedGoogle Scholar
  8. 8.
    Marchiori A, Mosena L, Prandoni P (2006) Superficial vein thrombosis: risk factors, diagnosis, and treatment. Semin Thromb Hemost 32(7):737–743PubMedCrossRefGoogle Scholar
  9. 9.
    Durkin MT, Turton EP, Scott DJ, Berridge DC (1999) A prospective randomised trial of PIN versus conventional stripping in varicose vein surgery. Ann R Coll Surg Engl 81(3):171–174PubMedCentralPubMedGoogle Scholar
  10. 10.
    Dwerryhouse S, Davies B, Harradine K, Earnshaw JJ (1999) Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial. J Vasc Surg 29(4):589–592PubMedCrossRefGoogle Scholar
  11. 11.
    van Rij AM, Jiang P, Solomon C, Christie RA, Hill GB (2003) Recurrence after varicose vein surgery: a prospective long-term clinical study with duplex ultrasound scanning and air plethysmography. J Vasc Surg 38(5):935–943PubMedCrossRefGoogle Scholar
  12. 12.
    Nael R, Rathbun S (2009) Treatment of varicose veins. Curr Treat Options Cardiovasc Med 11(2):91–103PubMedCrossRefGoogle Scholar
  13. 13.
    Enzler MA, van den Bos RR (2010) A new gold standard for varicose vein treatment? Eur J Vasc Endovasc Surg 39(1):97–98PubMedCrossRefGoogle Scholar
  14. 14.
    Navarro L, Min RJ, Bone C (2001) Endovenous laser: a new minimally invasive method of treatment for varicose veins—preliminary observations using an 810 nm diode laser. Dermatol Surg 27(2):117–122PubMedCrossRefGoogle Scholar
  15. 15.
    Corcos L, Dini S, De Anna D, Marangoni O, Ferlaino E, Procacci T et al (2005) The immediate effects of endovenous diode 808-nm laser in the greater saphenous vein: morphologic study and clinical implications. J Vasc Surg 41(6):1018–1024, discussion 25PubMedCrossRefGoogle Scholar
  16. 16.
    Proebstle TM, Gul D, Kargl A, Knop J (2003) Endovenous laser treatment of the lesser saphenous vein with a 940-nm diode laser: early results. Dermatol Surg 29(4):357–361PubMedCrossRefGoogle Scholar
  17. 17.
    Min RJ, Zimmet SE, Isaacs MN, Forrestal MD (2001) Endovenous laser treatment of the incompetent greater saphenous vein. J Vasc Interv Radiol 12(10):1167–1171PubMedCrossRefGoogle Scholar
  18. 18.
    Rasmussen LH, Bjoern L, Lawaetz M, Blemings A, Lawaetz B, Eklof B (2007) 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 Surg 46(2):308–315PubMedCrossRefGoogle Scholar
  19. 19.
    Porter JM, Moneta GL (1995) Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg 21(4):635–645PubMedCrossRefGoogle Scholar
  20. 20.
    Rutherford RB, Padberg FT Jr, Comerota AJ, Kistner RL, Meissner MH, Moneta GL (2000) Venous severity scoring: an adjunct to venous outcome assessment. J Vasc Surg 31(6):1307–1312PubMedCrossRefGoogle Scholar
  21. 21.
    Proebstle TM, Moehler T, Gul D, Herdemann S (2005) 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 Surg 31(12):1678–1683, discussion 83–4PubMedCrossRefGoogle Scholar
  22. 22.
    Oh CK, Jung DS, Jang HS, Kwon KS (2003) Endovenous laser surgery of the incompetent greater saphenous vein with a 980-nm diode laser. Dermatol Surg 29(11):1135–1140PubMedCrossRefGoogle Scholar
  23. 23.
    Duman E, Yildirim E, Saba T, Ozulku M, Gunday M, Coban G (2013) The effect of laser wavelength on postoperative pain score in the endovenous ablation of saphenous vein insufficiency. Diagn Interv Radiol 19:326–9PubMedGoogle Scholar
  24. 24.
    Beale RJ, Gough MJ (2005) Treatment options for primary varicose veins—a review. Eur J Vasc Endovasc Surg 30(1):83–95PubMedCrossRefGoogle Scholar
  25. 25.
    Rathbun SW, Kirkpatrick AC (2007) Treatment of chronic venous insufficiency. Curr Treat Options Cardiovasc Med 9(2):115–126PubMedCrossRefGoogle Scholar
  26. 26.
    Fischer R, Linde N, Duff C, Jeanneret C, Chandler JG, Seeber P (2001) Late recurrent saphenofemoral junction reflux after ligation and stripping of the greater saphenous vein. J Vasc Surg 34(2):236–240PubMedCrossRefGoogle Scholar
  27. 27.
    van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T (2009) Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg 49(1):230–239PubMedCrossRefGoogle Scholar
  28. 28.
    Proebstle TM, Vago B, Alm J, Gockeritz O, Lebard C, Pichot O (2008) Treatment of the incompetent great saphenous vein by endovenous radiofrequency powered segmental thermal ablation: first clinical experience. J Vasc Surg 47(1):151–156PubMedCrossRefGoogle Scholar
  29. 29.
    Kalteis M, Berger I, Messie-Werndl S, Pistrich R, Schimetta W, Polz W et al (2008) High ligation combined with stripping and endovenous laser ablation of the great saphenous vein: early results of a randomized controlled study. J Vasc Surg 47(4):822–829, discussion 9PubMedCrossRefGoogle Scholar
  30. 30.
    Darwood RJ, Theivacumar N, Dellagrammaticas D, Mavor AI, Gough MJ (2008) Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins. Br J Surg 95(3):294–301PubMedCrossRefGoogle Scholar
  31. 31.
    de Medeiros CA, Luccas GC (2005) Comparison of endovenous treatment with an 810 nm laser versus conventional stripping of the great saphenous vein in patients with primary varicose veins. Dermatol Surg 31(12):1685–1694, discussion 94PubMedCrossRefGoogle Scholar
  32. 32.
    Morrison N (2005) Saphenous ablation: what are the choices, laser or RF energy. Semin Vasc Surg 18(1):15–18PubMedCrossRefGoogle Scholar
  33. 33.
    Rasmussen LH, Bjoern L, Lawaetz M, Lawaetz B, Blemings A, Eklof B (2010) 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 Surg 39(5):630–635PubMedCrossRefGoogle Scholar
  34. 34.
    Huang Y, Jiang M, Li W, Lu X, Huang X, Lu M (2005) Endovenous laser treatment combined with a surgical strategy for treatment of venous insufficiency in lower extremity: a report of 208 cases. J Vasc Surg 42(3):494–501, discussionPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Mohammad Mozafar
    • 1
  • Khashayar Atqiaee
    • 2
  • Hamidreza Haghighatkhah
    • 2
  • Morteza Sanei Taheri
    • 2
  • Ali Tabatabaey
    • 3
  • Saran Lotfollahzadeh
    • 2
  1. 1.Shohada-e Tajrish Medical CenterTehranIran
  2. 2.Laser Application in Medical Sciences Research CenterShahid Beheshti University of Medical SciencesTehranIran
  3. 3.Department of Emergency MedicineShahid Beheshti University of Medical SciencesTehranIran

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