Ligation and stripping vs endovascular laser therapy for great saphenous vein reflux under local tumescent anaesthesia as day surgery procedures

Abstract

Purpose: Endovenous laser therapy (EVLT) has emerged as a popular treatment for great saphenous vein (GSV) reflux. We performed both sapheno-femoral ligation with stripping (L&S) and EVLT procedures using local tumescent anaesthesia in the treatment of GSV reflux and compared the outcomes. Methodology: One hundred and forty-two legs with GSV reflux received L&S (n=79) or EVLT (940nm) (n=63) under local tumescent anaesthesia as day surgery procedures between November 2008 and June 2011. The safety and efficacy as well as the early results including postoperative pain and the time before resuming normal activities were compared. Venous clinical severity score (VCSS) assessment and Duplex scans were performed at one month and one year after operation. Results: The duration of operation was significantly shorter for EVLT (Median: 70 minutes vs. 90 minutes). The success rate as defined by the absence of GSV reflux at one month Duplex scan were 100% in both groups. No major complications were recorded. Pain score was significantly higher in the EVLT group (Median: 2.86 vs. 1.71) although the numbers of analgesic required were comparable (Median: 3 tablets in EVLT vs. 2 tablets in L&S). The time before resuming normal activities was also similar (Median: 7 days in EVLT vs. 5 days in L&S). VCSS showed significant improvement at one year in both groups (Median: from 4 to 2 in EVLT; 5 to 1 in L&S). Recurrence of GSV reflux noted at one year was comparable (10% in EVLT vs. 4% in L&S). Conclusion: Both procedures were safe and effective in ablating GSV reflux with similar recurrence rate at one year. EVLT was associated with increased pain although the time before resuming normal activities was comparable to L&S.