Neovascularisation and recurrence 2 years after varicose vein treatment for sapheno-femoral and great saphenous vein reflux: a comparison of surgery and endovenous laser ablation.

OBJECTIVE: Neovascularisation is a major cause of recurrent varicosities following surgery. This prospective cohort study compares recurrence rates and the occurrence of neovascularisation following surgery or endovenous laser ablation (EVLA) for great saphenous vein reflux.

METHOD: 118 consecutive patients (72 female, 46 male, median age 48 [range 32-68 years]), 129 limbs were reviewed at a median of 24 months (range 18-30) after surgery (n=60 limbs) or EVLA (n=69 limbs) for primary sapheno-femoral and GSV reflux. Varicose vein recurrence, ultrasound detected groin neovascularisation and patient satisfaction (visual analogue scale) were recorded.

RESULTS: Recurrence rates at 2 years were: surgery group 4/60 (6.6%; mid-thigh perforator n=2, residual GSV with neovascularisation n=2), EVLA group 5/69 (7%; GSV recanalisation n=3 (all received <50 J/cm laser energy), mid-thigh perforator n=1, new anterior saphenous vein reflux n=1) p=0.631. Neovascularisation was detected in 11/60 (18%) of the surgery group and 1/69 (1%) of the EVLA group, p=0.001. Patient satisfaction rates were 90% and 88% respectively (p=0.37).

CONCLUSIONS: Although the frequency of recurrent varicosities 2 years after surgery and EVLA was similar, neovascularisation, a predictor of future recurrence, was less common following EVLA. Further, current recommendations on delivering > or =70 J/cm laser energy should reduce recanalisation rates and recurrence after EVLA.