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Endovenous laser ablation vs phlebectomy of foot varicose veins.
Journal of Vascular Surgery. Venous and Lymphatic Disorders 2023 November 16
OBJECTIVES: To compare the outcomes and complications of selected patients treated with endovenous laser ablation (EVLA) or ambulatory phlebectomy for foot varicose veins.
METHODS: From October 2016 to February 2022, selected patients undergoing EVLA (using 1470-nm with radial-slim or bare-tip fibers) or phlebectomy of foot varicose veins for cosmetic indications were analyzed and the outcomes were compared. Patients were classified according to the clinical, etiologic, anatomical, and pathophysiological (CEAP) classification. Anatomic criteria provided the basis for the decision to perform EVLA or phlebectomy. Clinical and ultrasound assessments were performed on postoperative days 7, 30, and 90 for visualization of the sapheno-femoral and sapheno-popliteal junctions and the deep venous system. Disease severity was graded with the venous clinical severity score (VCSS) and quality of life was measured with the Aberdeen Varicose Vein Questionnaire (AVVQ) before and after treatment. Treatment outcomes were evaluated based on changes in VCSS and AVVQ scores. The groups were also compared for procedure-related complications. Data were statistically analyzed in SPSS v. 20.0 using chi-square test, Student's t test, Mann-Whitney test, Wilcoxon test, and analysis of variance. The results were presented as mean (SD) or median (IQR).
RESULTS: The study included 270 feet of 171 patients. Mean patient age was 52.3 (SD, 13.1) years, ranging from 21 to 84 years; 133 (77.8%) were women. Of 270 feet, 113 (41.9%) were treated with EVLA and 157 (58.1%) with phlebectomy. The median preoperative CEAP class was 2 (IQR, 2-3) in the phlebectomy and EVLA groups, with no statistically significant difference between the groups (p=0.507). Dysesthesia was the most common complication in both groups. Only transient induration was significantly different between EVLA (7.1%) and phlebectomy (0.0%) (p=0.001). The two approaches had an equal impact on quality of life and disease severity.
CONCLUSION: Treatment complications were similar in phlebectomy and EVLA and to those previously described in the literature.
METHODS: From October 2016 to February 2022, selected patients undergoing EVLA (using 1470-nm with radial-slim or bare-tip fibers) or phlebectomy of foot varicose veins for cosmetic indications were analyzed and the outcomes were compared. Patients were classified according to the clinical, etiologic, anatomical, and pathophysiological (CEAP) classification. Anatomic criteria provided the basis for the decision to perform EVLA or phlebectomy. Clinical and ultrasound assessments were performed on postoperative days 7, 30, and 90 for visualization of the sapheno-femoral and sapheno-popliteal junctions and the deep venous system. Disease severity was graded with the venous clinical severity score (VCSS) and quality of life was measured with the Aberdeen Varicose Vein Questionnaire (AVVQ) before and after treatment. Treatment outcomes were evaluated based on changes in VCSS and AVVQ scores. The groups were also compared for procedure-related complications. Data were statistically analyzed in SPSS v. 20.0 using chi-square test, Student's t test, Mann-Whitney test, Wilcoxon test, and analysis of variance. The results were presented as mean (SD) or median (IQR).
RESULTS: The study included 270 feet of 171 patients. Mean patient age was 52.3 (SD, 13.1) years, ranging from 21 to 84 years; 133 (77.8%) were women. Of 270 feet, 113 (41.9%) were treated with EVLA and 157 (58.1%) with phlebectomy. The median preoperative CEAP class was 2 (IQR, 2-3) in the phlebectomy and EVLA groups, with no statistically significant difference between the groups (p=0.507). Dysesthesia was the most common complication in both groups. Only transient induration was significantly different between EVLA (7.1%) and phlebectomy (0.0%) (p=0.001). The two approaches had an equal impact on quality of life and disease severity.
CONCLUSION: Treatment complications were similar in phlebectomy and EVLA and to those previously described in the literature.
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