Five year follow up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia.
OBJECTIVE The objective of this study was to compare the long term results (groin related recurrence, great saphenous vein [GSV] occlusion rate, Clinical class, Etiology, Anatomy, and Pathophysiology [CEAP] staging, and quality of life [QoL] after the treatment of a GSV incompetence by saphenofemoral ligation and stripping (SFL/S) with endovenous laser ablation bare fiber, 980 nm (EVLA) METHODS Patients with GSV insufficiency and varicose veins were randomized to either undergo SFL/S or EVLA, both of which were performed under tumescent anesthesia. The long term results, which included the anatomic occlusion rate, varicose vein recurrence at the saphenofemoral junction (SFJ) relief of venous symptoms and QoL, were compared up to 5 years after treatment. RESULTS A total of 130 legs of 121 patients were treated with either SFL/S (n 68) or EVLA (n 62) In the first 12 months, three recanalizations of the GSV were observed after EVLA. Up to 5 years later, more recurrent varicose veins caused by neoreflux in incompetent tributaries of the SFJ were observed in after EVLA (31% 19/61) compared with SFL/S (7% 4/60; P .01) Neovascularization in the groin with clinically visible recurrence identified at 3 and 5 years post treatment follow up was only observed in the SFL/S group (n 6) After 5 years, clinically visible recurrences originating from the SFJ region after EVLA were observed 33% (20/61) compared with 17% of patients (10/60) after SFL/S (P .04) In both treatment groups, venous symptoms improved significantly. Patients in both groups reported a continuing significant cosmetic improvement measured on a visual analog scale of 1 to 10 (mean, 7.49; P .01) There was no difference in the CEAP staging and a standardized, non disease specific instrument for describing and valuing health states (EuroQol 5D) between the groups up to 5 years after follow up. CONCLUSIONS At the 5 year follow up, a significantly higher varicose vein recurrence rate originated at the SFJ region after EVLA compared with SFL/S. There were no differences in the relief of venous symptoms, CEAP staging, or general QoL between the groups.
Journal of vascular surgery