varicose veins
12/07/2015

Ref: EJVES Nov 2015

This is seriously interesting!! Most, if not all, surgeons have now ‘switched to’ endovenous thermal ablation (laser or RF). The endovenous therapy has proven safety and mid-term results. what about the long term recurrence? RELACS study has some logic : traditional surgery risks the recurrence to occur in the site of operation; the endothermic risks the recurrence to occur in other places. Here are the results:

Same Site Recurrence is More Frequent After Endovenous Laser Ablation Compared with High Ligation and Stripping of the Great Saphenous Vein: 5 year Results of a Randomized Clinical Trial (RELACS Study)

Interventions were performed on ambulatory and hospitalized patients at two vein centres, a university dermatology department (EVLA) and a specialized vein clinic (HLS). Four hundred patients suffering from GSV incompetence were assigned to EVLA or HLS of the GSV. One hundred and eighty five and 161 patients (=limbs), respectively, were treated per protocol. Main outcome measures were clinically recurrent varicose veins after surgery (REVAS classification, primary study objective), Duplex detected saphenofemoral recurrence, clinical venous severity scoring (Homburg Varicose Vein Severity Score), quality of life (Chronic Venous Insufficiency Questionnaire 2), side effects, and patient satisfaction 5 years after treatment.

Results

  • Two hundred and eighty one legs (81% of the study population) were evaluated with a median follow up of 60.4 (EVLA) and 60.7 months (HLS).
  • Overall, REVAS was similarly observed in both groups: 45% (EVLA) and 54% (HLS), p = .152.
  • Patients of the EVLA group showed significantly more clinical recurrences in the operated region (REVAS: same site): 18% vs. 5%, p = .002.
  • In contrast, more different site recurrences were observed in the HLS group: 50% vs. 31%, p = .002.
  • Duplex detected saphenofemoral refluxes occurred more frequently after EVLA: 28% vs. 5%, p < .001.
  • Both treatments improved disease severity and quality of life without any difference.

The results are summarised in this good figure:

Microsoft PowerPoint - yejvs_5830_EJVES 10179R rev 2 RELACS_5y_F

The figure is shown for educational purposes only and not for reuse.

Conclusion – don’t take it for granted!! need more work on best treatment options …

 

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