Evolution of an endovenous laser ablation practice for varicose veins

Smith, G.; Samuel, N.; Wallace, T.; Carradice, D.; Smith, George; Mazari, F.; Chetter, I.

Abstract

Objective We aimed to assess the evolution of an endovenous laser ablation (EVLA) practice in the management of varicose veins in a university teaching hospital vascular surgical unit, over five years. Methods This was a retrospective review of a prospectively collected database of patients undergoing EVLA for great saphenous vein incompetence and followed up for a year. For inter- and intragroup comparison, patients were divided into three groups: group A: endovenous access generally established at the perigenicular level (n = 105); group B: when practice changed to gain access at lowest point of demonstrable reflux (n = 70); and group C: when tumescence delivery changed from manual injections to delivery via peristaltic pump (n = 49). Outcomes including pain scores, time taken to return to normal functioning, quality of life (QoL), venous clinical severity scores (VCSS) and complication rates were evaluated. Results Intergroup analysis: increase in the length of vein treated and laser density delivered was observed over time, even as median procedure duration decreased (P < 0.001). An increase in sensory disturbance was noticed in group C (P = 0.047) while better Aberdeen Varicose Vein Questionnaire (AVVQ) (P = 0.004), SF-36® physical domains (P < 0.05) and patient satisfaction with treatment (P = 0.025) were recorded in the same group at 52 weeks. No significant difference was observed in technical failure, pain scores, return to normal functioning, VCSS and recurrence rates post-intervention. Intragroup analysis: QoL measures (AVVQ, SF-36®, EQ-5D) and VCSS scores demonstrated significant improvement at 12 and 52 weeks compared with baseline (P < 0.05). Conclusions Increase in length of vein treated and energy delivery seems to improve short-term outcomes; however, operators need to be wary of a possible concurrent increase in paraesthetic complications.

Citation

Samuel, N., Wallace, T., Carradice, D., Smith, G., Mazari, F., & Chetter, I. (2013). Evolution of an endovenous laser ablation practice for varicose veins. Phlebology, 28(5), 248-256. https://doi.org/10.1258/phleb.2011.011103

• Journal Article Type: Article
• Acceptance Date: May 3, 2013
• Online Publication Date: Feb 22, 2012
• Publication Date: 2013-08
• Journal: Phlebology
• Print ISSN: 0268-3555
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 28
• Issue: 5
• Pages: 248-256
• DOI: https://doi.org/10.1258/phleb.2011.011103
• Keywords: Cardiology and Cardiovascular Medicine; General Medicine
• Public URL: https://hull-repository.worktribe.com/output/432576
• Publisher URL: http://journals.sagepub.com/doi/10.1258/phleb.2011.011103