Endovenous Lasering Versus Ambulatory Phlebectomy of Varicose Tributaries in Conjunction with Endovenous Laser Treatment of the Great or Small Saphenous Vein

Abstract

Endovenous laser treatment (EVLT) is a widely used minimally invasive alternative to stripping of varicose veins involving the great and small saphenous veins. We expanded the applications to tributary varicosities and compared EVLT alone with combined EVLT and ambulatory phlebectomy. The study included 132 patients (76 males, 56 females) who were treated with EVLT and ambulatory phlebectomy. In addition, 133 patients (67 males, 66 females) were treated only with EVLT. Perforating vein reflux was identified in 65 patients in the combination group (49.2%) and in 121 patients (91.0%) in the EVLT only group (p=0.000). Postoperative complications and reoperation rates were compared between the two groups and the risk factors for reoperation analyzed. Ecchymosis (about 85%) and pain (>20%) were the major postoperative complications for both groups. There were no significant differences in the complications noted between the combination and EVLT only groups. During the follow-up period (25.6+/-12.8 months, range 15.5-37.3, in combination group; 11.8+/-8.2 months, range 1.3-18.5, in EVLT only group), residual tributary varicosities were noted in 12 patients (9.1%) in the combination group and in 11 (8.3%) in the EVLT only group (p=0.813). For patients who had reflux in the perforating veins, the reoperation rate was significantly higher compared to the patients without reflux in the perforating veins in each group (p=0.015 in combination group, p=0.006 in EVLT only group). The presence of perforating reflux was a significant risk factor (odds ratio=3.938, 95% confidence interval 1.05-14.78, p=0.042). EVLT as the sole therapy for the management of combined saphenous and tributary varicose veins was found to be safe and effective. However, longer follow-up is needed for confirmation of these findings.