Randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins

Abstract

Abstract Background Endovenous laser ablation (EVLA) is a popular minimally invasive treatment for varicose veins. Surgical treatment, featuring junctional ligation and inversion stripping, has shown excellent clinical and cost effectiveness. The clinical effectiveness of both treatments was compared within a randomized trial. Methods Some 280 patients were randomized equally into groups receiving either surgery or EVLA. Participants had primary, symptomatic, unilateral venous insufficiency, with isolated saphenofemoral junction incompetence, leading to reflux into the great saphenous vein. Outcomes included: quality of life (QoL), Venous Clinical Severity Score (VCSS), pain scores and time taken to return to normal function. Owing to the nature of the procedures, blinding was not possible. Results Both groups had significant improvements in VCSS after treatment (P < 0·001), which resulted in improved disease-specific QoL (Aberdeen Varicose Vein Questionnaire, P < 0·001) and quality-adjusted life year (QALY) gain (P < 0·001). The pain and disability following surgery impaired normal function, with a significant decline in five of eight Short Form 36 (SF-36®) domains (P < 0·001 to P = 0·029). Periprocedural QoL was relatively preserved following EVLA, leading to a significant difference between the two treatments in pain scores (P < 0·001), six of eight SF-36® domains (P = 0·004 to P = 0·049) and QALYs (P = 0·003). As a result, surgical patients took longer to return to work and normal activity (14 versus 4 days; P < 0·001). Complications were rare. Conclusion EVLA was as effective as surgery for varicose veins, but had a less negative impact on early postintervention QoL. Registration number: NCT00759434 (http://www.clinicaltrials.gov).