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Laser associated with less pain and faster recovery for small saphenous varicose veins

Endovenous laser ablation is as effective as surgery in the treatment of small saphenous
vein incompetence, but associated with less periprocedural pain, faster recovery and
fewer neural complications, according to a new randomised controlled trial.


The results of the study comparing endovenous laser ablation to surgery for small saphenous
varicose veins were presented at the Annual General Meeting of the Vascular Society
of Great Britain and Ireland (VSGBI) in Edinburgh, UK. “No randomised clinical trial
comparing treatment options for small saphenous vein incompetence exists. There is evidence
that small saphenous vein may behave differently to great saphenous vein incompetence

following treatment, hence available evidence for great saphenous vein cannot be extrapolated
to small saphenous vein management,” Nehemiah Samuel, clinical research fellow,
Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK, said. “This randomised
controlled trial aimed to compare the clinical efficacy and quality of life outcomes for
conventional surgery and endovenous laser ablation in the treatment of small saphenous vein
incompetence.” Patients with unilateral, primary saphenopopliteal junction incompetence
with small saphenous vein reflux were randomised equally into parallel groups receiving
either conventional surgery or endovenous laser ablation. Patients were assessed at baseline
and at one, six, 12 and 52 weeks. Outcome measures included Visual Analogue Pain scores;
quality of life (generic – SF36, EuroQol 5D and disease-specific AVVQ); Venous Clinical
Severity Score (VCSS); time taken to return to work and normal function; and complication
rates. One hundred and six patients (74 women), median age 47 (IQR 39–57) years were
recruited and randomised to surgery (n=53) or endovenous laser ablation (n=53). Samuel told
delegates that in an intragroup analysis, both groups demonstrated significant improvement
in VCSS (p<0.001), disease-specific AVVQ (p<0.001), generic SF36 and EQ5D quality of
life (p<0.05). In an intergroup analysis, postoperative pain was significantly lower after laser
(p<0.05), allowing an earlier return to work and normal function (p<0.001). S disturbance
was significantly lower in the laser ablation group 7.5% vs. surgery 26.4% (p=0.009). In
conclusion, Samuel noted that endovenous laser ablation can be as effective as surgery but
with the benefits of less pain, faster recovery and fewer neural complications.