WebMD Health News
Brenda Goodman, MA
Laura J. Martin, MD
Sept. 19, 2011 -- A newer, less-invasive technique that uses a laser to seal off bulging and uncomfortable varicose veins appears to work about as well as the standard surgery to remove the damaged vessels, a new study shows.
Neither procedure appears to be a guaranteed permanent fix for varicose veins, however.
Veins can grow back even after they're cut away, and sometimes the laser treatment fails to seal a vein completely, allowing the blood flow to gradually return.
Study researchers say patients should carefully weigh the benefits and risks with their doctors before deciding on the best treatment strategy.
The study is published in the Archives of Dermatology.
The study followed 346 men and women with varicose veins. They were randomly assigned to receive a standard surgical procedure called high ligation and saphenous vein stripping (HLS) or endovenous laser ablation (EVLT).
There were 185 people in the EVLT group and 161 in the HLS group. About 70% in each group were women. Their average age was 48.
After two years, the overall recurrence of varicose veins that caused symptoms like pain, heaviness, swelling, itching, or fatigue was similar among the two groups. By ultrasound study, more patients who had EVLT had their varicose veins return or reopen at the location of the procedure compared to those who had vein stripping surgery, however.
In the EVLT group, 32 people (18%) had their varicose veins come back in the area at the same place where they were originally treated compared to two people (1%) of the HLS group.
"The main implication of our study at this time point is that both procedures can be equally offered to the patients with [varicose veins]," says study researcher Knuth Rass, MD, a dermatologist at Saarland University Hospital in Homburg, Germany, in an email to WebMD. "But patients should be informed that there might be a risk for a higher rate of clinical recurrences beyond two years after EVLT."
Rass continues to follow the patients in the study and says he will know more about their longer-term recurrence rates next year.
The cost of vein stripping surgery ranges from $1,500 to $3,000 plus fees charged by the hospital or surgical center. Costs for EVLT range from $600 to $3,000, depending on how much of the vein needs to be treated. Insurance may pick up part of the tab, however, if the varicose veins are painful or debilitating.
Against expectations, researchers found that patients in the EVLT group had slightly more pain in the first week after their procedures compared to those who had vein stripping surgery, but it went away more quickly, too.
Patients in the EVLT group reported having pain for an average of eight days after their procedures compared to 17 days in the HLS group.
The EVLT group also experienced more skin discoloration after their procedures.
"This is an interesting paper, and gives a very similar picture that most other studies have shown," says Tristan R.A. Lane, MBBS, a vascular surgeon at Charing Cross Hospital and a researcher at Imperial College London, in an email to WebMD.
Lane reviewed the study but was not involved in the research.
"The overall message, as has become clear from most studies, is that the differing methods of vein treatment all work and provide good treatment if done well," Lane says.
Lane says because the study was started in 2004, it relied on an older laser technique that has since been advanced and may now provide better results.
He also notes that the kind of anesthesia used to perform the vein stripping in the study, called tumescent local anesthesia, is not a widely used technique and may have offered better results than a typical patient would get without it.
In the end, Lane says, the study won't change what he tells his patients.
"I usually explain that endovenous laser ablation [EVLT] provides a very good option, allowing patients to walk out of the clinic and go back to work the same or next day. I also explain that one treatment does not fit all and so we always consider other treatment methods," he says.
The study researchers agree.
Rass thinks EVLT may be best for younger patients because some research suggests that it's easier to fix return varicose veins after EVLT, and young patients are the most likely to need to have the surgery redone.
Vein-stripping, he says, may be best for older patients with larger veins or more advanced vessel damage.
But he says more research is needed to clarify which patients will see the most benefits, with the least recurrence, from each treatment.
"It will be the task for the future for us to characterize those patients having a risk for reopening and early clinical recurrence," he says. "This would help a lot to recommend the procedure with the best success for an individual patient."
SOURCES:Rass, K. Archives of Dermatology, Sept. 19, 2011.Knuth Rass, MD, dermatologist, Saarland University Hospital, Homburg, Germany.Tristan R.A. Lane, MBBS, vascular surgeon, Charing Cross Hospital; researcher, Imperial College London.
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