Comparison of Surgical Outcomes between Endovenous Laser Ablation and Conventional Surgery in Patients with Lower Limb Varicose Veins: A Prospective Interventional Study

Abstract

Introduction: Dilated, convoluted, subcutaneous veins measuring more than 3 mm in diameter when measured while upright and exhibiting reflux are called varicose veins. Varicose veins present a significant financial burden on the healthcare system, causing morbidity and lost work hours. Endovenous Laser Ablation (EVLA), a minimally invasive endovenous intervention that uses heat energy to induce aseptic inflammation of the vessel wall, obstructs and eliminates reflux. This technique has gained more attention recently because it eliminates the need for open surgical incisions. In contrast, standard surgery entails making an incision in the groin and excising the great saphenous vein anatomically to eliminate the abnormal reflux. Numerous studies have demonstrated the effectiveness of both thermal and non thermal endovenous methods in treating reflux in patients with axial venous reflux. However, there are limited comparative studies between various endovenous therapy modalities and traditional surgery concerning postoperative clinical outcomes. Aim: To evaluate the treatment outcomes of patients with Clinical (C), Aetiological (E), Anatomical (A), and Pathophysiological (P) - CEAP class C2-C6 who underwent either Endovenous Laser Ablation (EVLA) or conventional surgery for varicose veins. Materials and Methods: A prospective interventional study was conducted in the Department of General Surgery at Shri BM Patil Medical College Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, Karnataka, India, that included all patients with CEAP classes C2-C6, from July 2022 to July 2024. A block randomisation method was used to allocate patients into two groups to ensure an equal distribution of demographic variables. Group A (n=39) underwent EVLA and Group B (n=35) underwent flush ligation of the saphenofemoral junction and stripping. Data were collected with a particular focus on the duration of surgery, duration of hospital stay, postoperative pain, and cosmetic acceptance, with a follow-up period of six months. Additionally, potential procedural complications and recurrence rates were assessed after the six-month follow-up. Statistical analyses were performed using Statistical Packages for Social Sciences (SPSS) version 25.0. The Wilcoxon rank sum test and Chi-square test/Fisher’s-exact test were used, with a p-value of <0.05 considered significant. Results: The mean age of patients was noted to be 42.02±9.73 years in cases and 44.51±8.23 years in controls. In the present study, Group A (n=39) underwent EVLA, of which 36 were males and 3 were females. Group B (n=35) underwent conventional surgery, comprising 31 males and 4 females. The mean operating time in Group A (cases) was 38 minutes, whereas in Group B (controls), it was 60 minutes. Operative time was shortened by 37%, thereby avoiding prolonged exposure to anaesthetic medication. The mean pain score in Group A (cases) was 1.94, compared to 4.48 in Group B (controls). Postoperative pain was significantly reduced by 53% in the EVLA group compared to the conventional surgery group. The mean duration of postoperative hospital stay was 2.51 days for cases and 5.88 days for controls. The hospital stay was shortened by 57%, highlighting the efficacy of EVLA in enhancing patient recovery. In Group A (cases), post-EVLA burns were observed in 1 (2.5%) patient, which healed spontaneously over two weeks. Skin discolouration was observed in 3 (7.6%) patients, which reduced spontaneously over 3-4 weeks. In Group B (controls), seroma was observed in 1 (2.8%) patient, for which suture removal and drainage were performed, followed by secondary suturing on day 4, leading to a prolonged hospital stay. Bruising was observed in 1 (2.8%) patient, which resolved over 3-4 weeks. Wound infection at the groin incision site was observed in 5 (14.2%) patients, for which daily dressings were conducted, and intravenous antibiotics were continued for five days. The case group experienced significantly lower complications postoperatively when compared with the control group, with a p-value of 0.008. Patients were interviewed at the end of the follow-up period regarding their subjective cosmetic outcomes. Total 14 (40%) patients in the conventional surgery group were unsatisfied with their scars, whereas only 1 (2.5%) patient in the EVLA group expressed dissatisfaction with the cosmetic outcome. However, no recurrences were observed in either group during the six-month follow-up. Conclusion: The EVLA is a better treatment modality for primary lower limb varicosities in terms of procedure duration, postoperative pain, hospital stay duration, and overall cosmetic acceptance by the patients.

Keywords

• chronic venous hypertension
• chronic venous leg ulcers
• deep vein thrombosis
• laser treatment
• post thrombotic syndrome
• venous stasis