Tags

Type your tag names separated by a space and hit enter

Long-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins.
Br J Surg. 2018 12; 105(13):1759-1767.BJ

Abstract

BACKGROUND

Clinical guidelines recommend endovenous laser ablation (EVLA) over surgery based on short-term evidence, yet there are few studies reporting mid- to long-term outcomes. The aim of this study was to report the 5-year outcomes from an RCT of surgery versus EVLA for treatment of symptomatic great saphenous varicose veins.

METHODS

Patients with symptomatic varicose veins due to great saphenous vein (GSV) incompetence were followed up 5 years after enrolment in a randomized trial of either surgery (saphenofemoral junction ligation, GSV strip to the knee and multiple avulsions of varicosities) or EVLA plus multiple avulsions. Outcomes included: clinical recurrence, defined as new varicose veins greater than 3 mm in diameter; Venous Clinical Severity Score (VCSS); quality of life measured by means of Short Form 36, EuroQol Five Dimensions (EQ-5D™) and Aberdeen Varicose Vein Questionnaire (AVVQ); patient satisfaction; and duplex ultrasound examination (DUS) findings.

RESULTS

Some 218 of the 276 patients enrolled in the trial (79·0 per cent) were available for follow-up. Clinical recurrence was more frequent following surgery than EVLA at 5 years (34·3 versus 20·9 per cent; P = 0·010). Both groups demonstrated sustained significant improvements at 5 years over baseline in VCSS (surgery: median (i.q.r.) 1 (0-2) from 4 (3-5), P < 0·001; EVLA: 0 (0-1) from 4 (3-5), P < 0·001), AVVQ (surgery: 4·59 (0·56-9·78) from 13·69 (9·81-18·11), P < 0·001; EVLA: 3·35 (0·17 to 6·55) from 12·73 (9·41-17·32), P < 0·001) and EQ-5D™ (surgery: 1·000 (0·796-1·000) from 0·859 (0·796-1·000), P = 0·002; EVLA: 1·000 (0·796-1·000) from 0·808 (0·796-1·000), P = 0·002). VCSS was better for EVLA than surgery at 5 years (P = 0·031). Technical success assessed by DUS remained high at 5 years (85·4 per cent for surgery and 93·2 per cent for EVLA; P = 0·074). DUS-detected anatomical patterns of recurrence differed between the groups.

CONCLUSION

EVLA was more effective than surgery in preventing clinical recurrence 5 years after treatment of great saphenous varicose veins. Patient-reported outcome measures were similar. Registration number: NCT00759434 (http://www.clinicaltrials.gov).

Authors+Show Affiliations

Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK.Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK.Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK.Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK.Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK.Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK.Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK.Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK.Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

30132797

Citation

Wallace, T, et al. "Long-term Outcomes of Endovenous Laser Ablation and Conventional Surgery for Great Saphenous Varicose Veins." The British Journal of Surgery, vol. 105, no. 13, 2018, pp. 1759-1767.
Wallace T, El-Sheikha J, Nandhra S, et al. Long-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins. Br J Surg. 2018;105(13):1759-1767.
Wallace, T., El-Sheikha, J., Nandhra, S., Leung, C., Mohamed, A., Harwood, A., Smith, G., Carradice, D., & Chetter, I. (2018). Long-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins. The British Journal of Surgery, 105(13), 1759-1767. https://doi.org/10.1002/bjs.10961
Wallace T, et al. Long-term Outcomes of Endovenous Laser Ablation and Conventional Surgery for Great Saphenous Varicose Veins. Br J Surg. 2018;105(13):1759-1767. PubMed PMID: 30132797.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins. AU - Wallace,T, AU - El-Sheikha,J, AU - Nandhra,S, AU - Leung,C, AU - Mohamed,A, AU - Harwood,A, AU - Smith,G, AU - Carradice,D, AU - Chetter,I, Y1 - 2018/08/22/ PY - 2018/03/22/received PY - 2018/05/29/revised PY - 2018/06/26/accepted PY - 2018/8/23/pubmed PY - 2019/4/30/medline PY - 2018/8/23/entrez SP - 1759 EP - 1767 JF - The British journal of surgery JO - Br J Surg VL - 105 IS - 13 N2 - BACKGROUND: Clinical guidelines recommend endovenous laser ablation (EVLA) over surgery based on short-term evidence, yet there are few studies reporting mid- to long-term outcomes. The aim of this study was to report the 5-year outcomes from an RCT of surgery versus EVLA for treatment of symptomatic great saphenous varicose veins. METHODS: Patients with symptomatic varicose veins due to great saphenous vein (GSV) incompetence were followed up 5 years after enrolment in a randomized trial of either surgery (saphenofemoral junction ligation, GSV strip to the knee and multiple avulsions of varicosities) or EVLA plus multiple avulsions. Outcomes included: clinical recurrence, defined as new varicose veins greater than 3 mm in diameter; Venous Clinical Severity Score (VCSS); quality of life measured by means of Short Form 36, EuroQol Five Dimensions (EQ-5D™) and Aberdeen Varicose Vein Questionnaire (AVVQ); patient satisfaction; and duplex ultrasound examination (DUS) findings. RESULTS: Some 218 of the 276 patients enrolled in the trial (79·0 per cent) were available for follow-up. Clinical recurrence was more frequent following surgery than EVLA at 5 years (34·3 versus 20·9 per cent; P = 0·010). Both groups demonstrated sustained significant improvements at 5 years over baseline in VCSS (surgery: median (i.q.r.) 1 (0-2) from 4 (3-5), P < 0·001; EVLA: 0 (0-1) from 4 (3-5), P < 0·001), AVVQ (surgery: 4·59 (0·56-9·78) from 13·69 (9·81-18·11), P < 0·001; EVLA: 3·35 (0·17 to 6·55) from 12·73 (9·41-17·32), P < 0·001) and EQ-5D™ (surgery: 1·000 (0·796-1·000) from 0·859 (0·796-1·000), P = 0·002; EVLA: 1·000 (0·796-1·000) from 0·808 (0·796-1·000), P = 0·002). VCSS was better for EVLA than surgery at 5 years (P = 0·031). Technical success assessed by DUS remained high at 5 years (85·4 per cent for surgery and 93·2 per cent for EVLA; P = 0·074). DUS-detected anatomical patterns of recurrence differed between the groups. CONCLUSION: EVLA was more effective than surgery in preventing clinical recurrence 5 years after treatment of great saphenous varicose veins. Patient-reported outcome measures were similar. Registration number: NCT00759434 (http://www.clinicaltrials.gov). SN - 1365-2168 UR - https://www.unboundmedicine.com/medline/citation/30132797/Long_term_outcomes_of_endovenous_laser_ablation_and_conventional_surgery_for_great_saphenous_varicose_veins_ L2 - https://doi.org/10.1002/bjs.10961 DB - PRIME DP - Unbound Medicine ER -