Treatment of recurrent varicose veins of the great saphenous vein by conventional surgery and endovenous laser ablation

Objective: Varicose vein recurrence of the great saphenous vein (GSV) is a common, costly, and complex problem. The aim of the study was to assess feasibility of endovenous laser ablation (EVLA) in recurrent varicose veins of the GSV and to compare this technique with conventional surgical reintervention. Methods: Case files of all patients treated for GSV varicosities were evaluated and recurrences selected. Demographics, duplex scan findings, CEAP classification., perioperative data, and follow-up examinations were all registered. A questionnaire focusing on patient satisfaction was administered. Results: Sixty-seven limbs were treated with EVLA and 149 were surgically treated. General and regional anesthesia were used more in the surgery group (P < .001). Most complications were minor and self-limiting. Wound infections (8% vs 0%; P < .05) and parasthesia (27% vs 13%; P < .05) were more abundant in the surgery group, whereas the EVLA-treated patients reported more delayed tightness (17% vs 31%; P < .05). Surgically-treated patients suffered less postoperative pain (P <.05) but reported a higher use of analgesics (P <.05). Hospital stay in the surgery group was longer (P <.05) and they reported a longer delay before resuming work (7 vs 2 days; P < .0001). Patient satisfaction was equally high in both groups. At 25 weeks of follow-up, re-recurrences occurred in 29% of the surgically-treated patients and in 19% of the EVLA-treated patients (P = .511). Conclusion: EVLA is feasible in patients with recurrent varicose veins of the GSV. Complication rates are lower and socioeconomic outcome is better compared to surgical reintervention. (J Vasc Surg 2009;50:1106-13.)