Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins

Abstract

BackgroundEndovenous ablation techniques and ultrasound‐guided foam sclerotherapy (UGFS) have largely replaced open surgery for treatment of great saphenous varicose veins. This was a randomized trial to compare the effect of surgery, endovenous laser ablation (EVLA) (with phlebectomies) and UGFS on quality of life and the occlusion rate of the great saphenous vein (GSV) 12 months after surgery.MethodsPatients with symptomatic, uncomplicated varicose veins (CEAP class C2–C4) were examined at baseline, 1 month and 1 year. Before discharge and at 1 week, patients reported a pain score on a visual analogue scale. Preoperative and 1‐year assessments included duplex ultrasound imaging and the Aberdeen Varicose Vein Severity Score (AVVSS).ResultsThe study included 214 patients: 65 had surgery, 73 had EVLA and 76 had UGFS. At 1 year, the GSV was occluded or absent in 59 (97 per cent) of 61 patients after surgery, 71 (97 per cent) of 73 after EVLA and 37 (51 per cent) of 72 after UGFS (P < 0·001). The AVVSS improved significantly in comparison with preoperative values in all groups, with no significant differences between them. Perioperative pain was significantly reduced and sick leave shorter after UGFS (mean 1 day) than after EVLA (8 days) and surgery (12 days).ConclusionIn comparison with open surgery and EVLA, UGFS resulted in equivalent improvement in quality of life but significantly higher residual GSV reflux at 12‐month follow‐up.

High-precision, non-invasive anti-microvascular approach via concurrent ultrasound and laser irradiation

“…a blood vessel), the laser-induced photoacoustic wave can converge into the center and achieve a significantly high acoustic pressure and produce cavitation44, which is referred to as “cold bubbles” and has been observed in cells45. Unlike other use of therapeutic ultrasound and laser irradiation4647484950, when ultrasound and laser irradiation are concurrently applied, a portion of the ultrasound waves can modulate the transient thermal-elastic negative stress produced through photospallation, which will increase the cavitation efficiency because of the greater negative pressure31. One of the key features of photoacoustic cavitation is that cavitation may be induced at a laser energy level that is much lower than that needed for laser thermal therapies (such as photothermolysis and photocoagulation) because photoacoustic cavitation is not a strictly thermal effect.…”

Comparison of endovenous laser treatment and high ligation in treatment of limb varicosity: A meta‐analysis

“…There were 11 articles comprising a total sampling size of 1145 patients with lower limb varicosity meeting all inclusion and exclusion criteria, and then were included in this meta‐analysis. The sample sizes of these studies vary from 40 to 173.…”

Modern methods of conservative and surgical treatment of patients with lower limb varicose vein disease

“…В отличие от ЭВЛО и РЧО этот метод не требует применения анестезии, потенциально сокращая время процедуры и приводя к менее значимым экхимозам и отекам конечности. В одном из исследований [36] были продемонстрированы высокая эффективность и переносимость метода с полной окклюзи-ей вены в 92% случаев в течение 2 лет наблюдения. Помимо этого, было выявлено статистически значимое снижение выраженности симптоматики по сравнению с исходным уровнем (р<0,001).…”

“…Peripheral artery and vein disease В отличие от предыдущего исследования эта тенденция оказалась статистически значимой с бо`льшим успехом для ЭВЛО и оперативного лечения [35,36]. Третье, более крупное РКИ включало 798 больных [33][34][35].…”

“…В случае ЭВЛО через 1 нед после лечения наблюдались более выраженные экхимозы по сравнению с РЧО (р=0,01). Через 1 год отмечена меньшая эффективность РЧО, но качество жизни значительно улучшилось в обеих группах без значимых различий [36]. Второе РКИ из 69 пациентов продемонстрировало преимущество РЧО в периоперационном периоде со значительным снижением выраженности болевого синдрома, которое сохранялось до 2 нед после лечения, а также более низкую выраженность экхимозов [36].…”