Endovascular Laser Therapy versus Open Surgery for the Treatment of Primary Varicose Veins of the Lower Limb

Abstract

Background: Venous drainage of the lower extremities is accomplished by a network of superficial veins connected to the deep veins by small perforator veins. Through a variety of pathophysiological mechanisms, weakness develops in the vein wall that results in varicosity over time. Varicosities typically form in the greater and lesser saphenous veins but also develop in branch vessels. Obstruction of the iliac veins or inferior vena cava can result in extensive varicose veins Objectives: The aim of this work is to compare the outcome of endovascular laser therapy versus open surgery in management of primary varicose veins in lower limb. Patients and Methods: Type of study is a prospective, randomized, clinical study. This study was conducted on 30 patients with primary varicose veins of the lower limb, 15 patients were subjected to endovascular laser therapy for treatment of varicose veins of the lower limb (EVLA group) and 15 patients were managed by standard open surgery for treatment of varicose veins of the lower limb (surgery group). The patients were randomized selected from surgery clinic in Eldemerdash Hospital. The work was carried out in the period from June 2017 to December 2018. Results: Both groups were well matched regarding age(P=0.352) and sex (P=0.713), type of vein diseased(P=0.913), CEAP classification (P=0.910) and also regarding BMI (P=0.761). Regarding preoperative venous clinical severity score, the median(IQR) for group A (surgery group) was (5), and for group B (laser group) was (5) without statistical significant differences between both groups (P value =0.524). Many studies have shown that there was some difference in between two methods of treatment of primary varicose veins of the lower limbs open vascular surgery and endovascular laser therapy. Regarding Six weeks post-operative VCSS assessment, the VCSS score in the surgery group was statistically significantly higher (p < 0.001). However, at one and two years after the intervention The VCSS scores converged and the difference between the groups was no longer statistically significant. Conclusion: The presented results show that intreatment of varicose veins with both endovascular laser ablation and open surgery there was improvement in the clinical status of the patient occur after both but EVLA was more effective early which was observed by measuring venous clinical severity score. EVLA show distinct advantages over open surgery especially in post operative pain, analgesia use and time needed to return to work.