Varicose Veins Surgery – Classical (Ligation-Stripping) or Laser?

Varicose veins are embarrassing because they are unsightly; they may be dark purple or blue in color, and appear twisted and bulging.  But for some, they can cause an aching pain and discomfort. As many as 25% to 35% of adults have chronic venous insufficiency caused by varicose veins.  One classical treatment involves ligation of the affected vein in the groin, and removing it through several small incisions. An outpatient procedure for most people, removing the vein doesn’t affect circulation in the leg because deeper veins assume care of returning blood to the heart.  More recently, endovenous laser ablation (destruction) has been used. To compare this approach with the more classical surgery, researchers in Germany randomized 400 adults with great saphenous vein varicosity to endovenous laser ablation or ligation-and-stripping.  Their results are published in the Archives of Dermatology.

The follow-up period was 2 years, with recurrence during this time as the major focus of the study.  Clinical recurrence was reported in 16% of the endovenous laser group and 23% of the ligation group; the difference between the two groups was not statistically significant.  A clinical score - the Homburg Varicose vein Severity Score – as well as a quality-of-life scale revealed no differences between the two methods.  There were more side effects with the laser treatment: mild inflammatory reactions, feeling of tightness in the limb, and discoloration; however, there were no major complications in either group.        

Using an ultrasonic test for venous reflux, a higher rate of refluxes was detected with the laser treatment method; however, the self-rated cosmetic outcome for these patients was significantly better.  The bottom line – both methods were found to be comparably safe and effective with good patient acceptance.  The endovenous laser treatment showed minor advantages from the patients’ viewpoint at the 2-year end-point, but there will be a re-evaluation of findings at the 5-year follow-up, we are told.