The success of any treatment method for varicose veins is measured by:
- Alleviation of symptoms of varicose veins
- Effective removal of the varicose veins responsible for symptoms
- Early complications (such as infection, bleeding, pain, deep vein thrombosis, haematoma)
- Late complications (numbness, scarring, discolouration, nerve damage, and recurrence of veins)
- Acceptability by patients
Comparison of open surgery with minimally invasive (endovenous) treatment of varicose veins.
The traditional method was open surgery but newer techniques of minimally invasive endovenous surgery (Laser EVLT, or radiofrequency VNUS ablation techniques) have largely replaced open surgery now. They offer comparable effective removal of the varicose veins, and alleviation of symptoms, and longer term results.
However, they have reduced surgical time and lower early complications. They are also more acceptable to patients as they can resume normal activities much sooner. Open surgery may still have a role to play in selected patients with recurrent varicose veins or if multiple tributaries of the main superficial vein require removal.
How do various minimally invasive techniques compare to each other?
Recently, the results of endovenous ablation with radiofrequency Closure FAST (VNUS) catheter have been compared to the conventional laser (EVLT) treatment in a controlled trial (the RECOVERY trial*). The two treatments were compared in terms of post-operative pain, bruising, and complications of deep vein thrombosis, numbness, and pigmentation.
The results indicated that at one month bruising was less common in patients treated with VNUS. The laser treated patients experienced more pain for up to 2 weeks after treatment but there was no difference in terms of pain levels at one month. There were no differences in terms of successful occlusion of the long saphenous vein (both 100%), or complications such as pigmentation, deep vein thrombosis, or numbness between VNUS and EVLT. Although study is seemingly well conducted, it must be noted that it was sponsored by the company making the VNUS Closure FAST catheters. Therefore, it would be interesting to know if others can reproduce the findings of this study.
In an earlier interesting study patients with bilateral varicose veins were treated using EVLT in one leg and VNUS technique in other chosen at random. Although the overall complication rates were the same, a higher proportion of the veins treated by VNUS technique remained closed compared to EVLT treated veins after one year follow up.
*Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY study). Almeida JI, Kaufman J, Göckeritz O, Chopra P, Evans MT, Hoheim DF, Makhoul RG, Richards T, Wenzel C, Raines JK.
J Vasc Interv Radiol. 2009 Jun;20(6):752-9.