Recurrent Varices after Surgery (REVAS), a Consensus Document

Perrin, Michel; Jj, Guex; Ruckley, C. V.; DePalma, Ralph G.; Royle, John P.; Eklöf, Bo; Nicolini, Philippe; Jantet, G.

doi:10.1177/096721090000800402

Cited by 70 publications

References 51 publications

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Comparable Effectiveness of Endovenous Laser Ablation and High Ligation With Stripping of the Great Saphenous Vein

Rass

Frings²,

Glowacki³

et al. 2012

Arch Dermatol

126

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Objective: To compare the clinical efficacy and safety of endovenous laser treatment (EVLT) with high ligation and stripping (HLS) as standard treatment for great saphenous vein (GSV) insufficiency. Design: Two-center randomized controlled trial with 2-year follow-up. Setting: Interventions were performed on ambulatory and hospitalized patients at 2 vein centers, a university dermatology department (EVLT-treated group), and a specialized vein clinic (HLS-treated group). Patients: Random sample of 400 patients with GSV insufficiency. Interventions: Patients were assigned (1:1) to EVLT or HLS of the GSV from September 2004 through March 2007; 185 and 161 patients (limbs), respectively, were treated per protocol. Main Outcome Measures: Clinically recurrent varicose veins after surgery (REVAS classification, primary study objective), duplex-detected saphenofemoral recurrence, clinical venous severity scoring (Homburg Varicose Vein Severity Score), hemodynamics (venous refilling time), quality of life (Chronic Venous Insufficiency Questionnaire 2), adverse effects, and visual analog scalebased evaluations of patients' satisfaction. Results: Clinically recurrent varicose veins after surgery were similarly observed in both groups: 16.2% (EVLTtreated group) vs 23.1% (HLS-treated group); P=.15. Duplex-detected saphenofemoral refluxes occurred significantly more frequently after EVLT (17.8% vs 1.3%; PϽ.001). Both treatments equally improved medical condition (Homburg Varicose Vein Severity Score) and diseaserelated quality of life. Endovenous laser treatment caused more adverse effects (phlebitic reaction, tightness, dyspigmentation) but revealed advantages concerning hemodynamics, recovery, and cosmetic outcome. Conclusions: Both EVLT and HLS are comparably safe and effective procedures to treat GSV incompetence. The significantly higher rate and the course of duplexdetected saphenofemoral recurrences after EVLT remain a matter of further investigations.

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