Clinical outcomes and quality of life 5 years after a randomized trial of concomitant or sequential phlebectomy following endovenous laser ablation for varicose veins

El-Sheikha, J.; Nandhra, S.; Carradice, D.; Wallace, T.; Samuel, N.; Smith, George; Chetter, I. C.

Abstract

BackgroundEndovenous laser ablation (EVLA) is a popular treatment for superficial venous insufficiency. Debate continues regarding the optimal management of symptomatic varicose tributaries following ablation of the main saphenous trunk. This randomized trial compared the 5-year outcomes of endovenous laser therapy with ambulatory phlebectomy (EVLTAP) with concomitant ambulatory phlebectomy, and EVLA alone with sequential treatment if required following a delay of at least 6 weeks.MethodsPatients undergoing EVLA for great saphenous vein insufficiency were randomized to receive EVLTAP or EVLA alone with sequential phlebectomy, if required. Outcomes included disease-specific quality of life (QoL) (Aberdeen Varicose Vein Questionnaire; AVVQ), requirement for secondary procedures, clinical severity (Venous Clinical Severity Score; VCSS), residual and recurrent varicose tributaries, and generic QoL. Patients were followed up for 5 years.ResultsFifty patients were randomized equally into two parallel groups. The EVLTAP group had lower VCSS scores at 12 weeks (median 0 (i.q.r. 0-1) versus 2 (0-2); P <0·001), and lower AVVQ scores at 6 weeks (median 7·9 (i.q.r. 4·1-10·7) versus 13·5 (10·9-18·1); P < 0·001) and 12 weeks (2·0 (0·4-7·7) versus 9·6 (2·2-13·8); P = 0·015). VCSS and AVVQ scores were equivalent by 1 year, but only after 16 of 24 patients in the EVLA group, compared with one of 25 in the EVLTAP group (P < 0·001), had received a secondary intervention. From 1 to 5 years both groups had equivalent outcomes.ConclusionEVLA with either concomitant or sequential management of tributaries is acceptable treatment for symptomatic varicose veins, with both treatments achieving excellent results at 5 years. Concomitant treatment of varicosities is associated with optimal improvement in both clinical disease severity and QoL.

Citation

El-Sheikha, J., Nandhra, S., Carradice, D., Wallace, T., Samuel, N., Smith, G., & Chetter, I. C. (2014). Clinical outcomes and quality of life 5 years after a randomized trial of concomitant or sequential phlebectomy following endovenous laser ablation for varicose veins. British journal of surgery, 101(9), 1093-1097. https://doi.org/10.1002/bjs.9565

• Journal Article Type: Article
• Acceptance Date: Apr 17, 2014
• Online Publication Date: Jun 11, 2014
• Publication Date: 2014-08
• Journal: British Journal of Surgery
• Print ISSN: 0007-1323
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 101
• Issue: 9
• Pages: 1093-1097
• DOI: https://doi.org/10.1002/bjs.9565
• Keywords: Surgery
• Public URL: https://hull-repository.worktribe.com/output/432658