For adults with great saphenous vein incompetence, how do endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and ultrasound-guided foam sclerotherapy (UGFS) compare with high ligation and stripping (HL/S)?

2021 ◽  
Author(s):  
Sera Tort ◽  
Benilde Cosmi
Keyword(s):  
Radiofrequency Ablation ◽  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
High Ligation ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Endovenous Laser Ablation

Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein? Review

Vascular ◽  
2016 ◽  
Vol 24 (6) ◽  
pp. 649-657 ◽  
Author(s):  
Renata Balint ◽  
Akos Farics ◽  
Krisztina Parti ◽  
Laszlo Vizsy ◽  
Jozsef Batorfi ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Success Rates ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Endovenous Laser Ablation

Objective The aim of this review article was to evaluate the long-term technical success rates of the known endovenous ablation procedures in the treatment of the incompetence of the great saphenous vein. Methods A literature search was conducted in the PubMed-database until the 5 January 2016. All publications with four to five years follow-up were eligible. Meta-analysis was performed by the IVhet-model. Results Eight hundred and sixty-two unique publications were found; 17 of them were appropriate for meta-analysis. Overall, 1420 limbs were included in the trial, 939 for endovenous laser ablation, 353 for radiofrequency ablation and 128 for ultrasound guided foam sclerotherapy. Overall, technical success rates were 84.8% for endovenous laser ablation, 88.7% for radiofrequency ablation and 32.8% for ultrasound guided foam sclerotherapy. There were no significant differences between endovenous laser ablation, radiofrequency ablation and ultrasound guided foam sclerotherapy regarding the great saphenous vein reopening ( p = 0.66; OR: 0.22; 95% of CI: 0.08–0.62 for radiofrequency ablation vs. endovenous laser ablation; p = 0.96; OR: 0.11; 95% of CI: 0.06–0.20 for endovenous laser ablation vs. ultrasound guided foam sclerotherapy; p = 0.93; OR: 3.20; 95% of CI: 0.54–18.90 for ultrasound guided foam sclerotherapy vs. radiofrequency ablation). Conclusion Both endovenous laser ablation and radiofrequency ablation are efficient in great saphenous vein occlusion on the long term. Lacking long-conducted large trials, the efficacy and reliability of ultrasound guided foam sclerotherapy to treat great saphenous vein-reflux is not affirmed.

scholarly journals Treatment of varicose great saphenous veins with saphenofemoral junction insufficiency – what is the evidence? *

Phlebologie ◽  
2020 ◽  
Vol 49 (02) ◽  
pp. 87-97
Author(s):  
René Gordon Holzheimer ◽  
Alfred Obermayer ◽  
Thomas Noppeney
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
High Ligation ◽  
Ultrasound Guided ◽  
Endovenous Laser Ablation ◽  
Randomized Controlled ◽  
Randomized Studies ◽  
Randomized Controlled Studies

AbstractThe results of studies on treatment of the great saphenous vein (GSV) with sapheno-femoral-junction (SFJ) insufficiency are unclear. Guidelines, however, recommend endovenous laser ablation (EVLA) and ultrasound-guided-foamsclerotherapy (UGFS) for symptomatic varicose large saphenous vein. There are numerous studies on GSV treatment but only a few randomized studies with a follow-up of two years and more. Meta-analyses in most instances included all studies and do not focus on studies with a follow-up of two years and longer. Methods A literature research in Pubmed used the keyword “great saphenous vein treatment”, “large saphenous vein treatment”, “varicose therapy” in conjunction with “randomized controlled trial”, “meta-analysis” and “systematic review”. Of 128 studies only 24 randomized controlled studies investigated the effect of High Ligation and Continuous Stripping (HL + CS), Endovenous Laser Ablation (EVLA), Radiofrequency Ablation (RFA), Liquid Sclerotherapy (LS), and Ultrasound-Guided-Foam-Sclerotherapy (UGFS) and a follow-up of two and more years. Study evaluation included “reflux”, “recurrence”, “therapy technique”, numbers of patients/legs treated, length of follow-up, and primary/secondary study endpoints. Results Most of these studies investigated surgical High Ligation and Continuous Stripping (HL + CS) with a follow-up of two years and more. This technique served a reference technique for other techniques in randomized controlled studies. However, there are major differences in techniques, mode of treatment, definitions, criteria for exclusion and inclusion, and study endpoints.The surgery study group included 1915 legs in 19 studies, the EVLA group 1047 legs in 12 studies and 240 legs in 3 studies with combined HL + EVLA treatment. RFA was used in 299 legs in 4 studies, UGFS in 661 legs in 5 studies, combined UGFS + HL in 39 legs and LS + HL in 92 legs in one study each.EVLA is associated with more reflux and recurrence when compared to HL + CS. RFA shows similar reflux and recurrence rates as surgery. In most studies UGFS and LS is followed by more reflux and recurrence when compared to surgery. Conclusion Due to heterogeneity of studies comparing study results of HL + CS, EVLA, RFA, LS and UGFS is not reliable. UIP or ECOP may form a commission to establish uniform, reliable and accepted study designs for varicose vein treatment to improve comparability of further randomized studies.

Current clinical evidence on endovenous laser ablation (EVLA) from randomised trials

Phlebologie ◽  
2016 ◽  
Vol 45 (04) ◽  
pp. 201-206 ◽  
Author(s):  
K. Rass
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Term Treatment ◽  
High Ligation ◽  
Control Group ◽  
Foam Sclerotherapy ◽  
Endovenous Laser Ablation ◽  
Treatment Approaches ◽  
Long Term Treatment

SummaryBackground Endovenous laser ablation (EVLA) is globally counted among the most frequently administered methods to treat saphenous vein incompetence. Technical development proceeded in three particular steps: EVLA #1 – Diode lasers linearly emitting wavelengths from 810 to 980 nm through optical bare fibres; EVLA #2 – Diode or Nd:YAG lasers emitting wavelengths from 1064 to 1500 nm; EVLA #3 – Modified optical fibres warranting an optimised emission geometry by centralisation of the fibre tip (Tulip-fibre, Jacket-tip) or radial emission of the laser beam. Due to the number of different EVLA techniques their value compared with standard surgery (high ligation and stripping, HLS) and other endovascular approaches has to be questioned.Methods Selective literature analysis based on a systematic PubMed search focussed on randomised controlled trials (RCT) comparing EVLA with HLS and other thermal or nonthermal ablation techniques – radiofrequency ablation (RFA), ultrasound guided foam sclerotherapy (UGFS), endothermal steam ablation (EStA).Results The search terms “endovenous”, “laser”, “varicose vein” resulted in 509 publications, hereof 57 RCTs, hereof 24 randomised studies comparing EVLA with other treatment approaches: 15 studies comprise comparisons with standard surgery and further 9 studies with other endovenous techniques. 6 RCTs contain long-term followup data on EVLA #1 vs. HLS suggesting superiority of HLS in terms of same site clinical and duplex detected recurrence from the groin. 15 RCTs are reporting short-term results clearly demonstrating inferiority of EVLA #1 against EVLA #2, EVLA #3, and RFA with respect to postoperative complaints and patients’ quality of life.Conclusions The first generation endovenous laser systems are disadvantageous or even harmful as compared with more advanced EVLA techniques and RFA in terms of patients’ complaints and side effects. Furthermore, evidence is rising that EVLA #1 is inferior to standard surgery regarding long-term treatment efficacy. Therefore, the application of EVLA #1 in the treatment of saphenous vein incompetence cannot be recommended any longer. In view of the more recently published RCTs reporting long-term superiority of standard surgery, HLS should still be implemented as control group in studies investigating endovenous treatment approaches.

Endoluminal thermal ablation of the great saphenous vein (GSV) insufficiency

Phlebologie ◽  
2016 ◽  
Vol 45 (06) ◽  
pp. 357-362 ◽  
Author(s):  
C. Zollmann ◽  
P. Zollmann ◽  
J. Veltman ◽  
A. Gräser ◽  
I. Berger ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Laser Ablation ◽  
Prospective Study ◽  
Saphenous Vein ◽  
Thermal Ablation ◽  
Great Saphenous Vein ◽  
Treatment Technique ◽  
Ultrasound Guided ◽  
Previously Treated

SummaryTo evaluate and compare the fiveyear outcome after treatment of a varicose GSV by endovenous thermal laser ablation (EVLA) and radiofrequency ablation (RFA).In this non-randomized, prospective study, patients treated in 2007 and 2008 for complete varicosis of the GSV (CEAP: C2–C6) were divided according to the treatment technique used into three groups: RFA (VNUS ClosureFast™), EVLA 980 nm (ELVeS 980™) and EVLA 1470 nm (ELVeS 1470™). Ultrasound-guided follow-up consultations were conducted 3 days, 3 months, 1 year and 5 years after treatment.589 patients with 643 GSVs (223 RFA, 185 EVLA 980, 235 EVLA 1470) were treated under tumescent local anaesthesia. No major complications occurred and minor complications were rare (4.7–12.2 %, p=0.135).66 % (RFA), 15 % (EVLA 980) and 32 % (EVLA 1470) of the patients were pain-free without post-operative analgesics. After 5 years, 86 % (RFA), 90 % (EVLA 980) and 93 % (EVLA 1470) of the veins were occluded (p=0.096). Ultrasound imaging revealed reflux in treated GSVs in 5–8 % of cases (p=0.73). A second ablation of the previously treated GSV was required in 5 % (RFA), 2 % (EVLA 980) and 2 % (EVLA 1470) of the patients (p=0.28).Endoluminal thermal ablation is an easy, safe and well tolerated method for the treatment of varicosis. Radiofrequency ablation is less painful than EVLA. RFA and EVLA 1470 are equally effective for vein closure.

scholarly journals A randomized prospective long-term (>1 year) clinical trial comparing the efficacy and safety of radiofrequency ablation to 980 nm laser ablation of the great saphenous vein

2016 ◽  
Vol 32 (6) ◽  
pp. 415-424 ◽  
Author(s):  
Malcolm Sydnor ◽  
John Mavropoulos ◽  
Natalia Slobodnik ◽  
Luke Wolfe ◽  
Brian Strife ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Radiofrequency Ablation ◽  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Clinical Severity ◽  
Endovenous Laser Ablation ◽  
Venous Clinical Severity Score ◽  
Superficial Venous Insufficiency

Purpose To compare the short- and long-term (>1 year) efficacy and safety of radiofrequency ablation (ClosureFAST™) versus endovenous laser ablation (980 nm diode laser) for the treatment of superficial venous insufficiency of the great saphenous vein. Materials and methods Two hundred patients with superficial venous insufficiency of the great saphenous vein were randomized to receive either radiofrequency ablation or endovenous laser ablation (and simultaneous adjunctive therapies for surface varicosities when appropriate). Post-treatment sonographic and clinical assessment was conducted at one week, six weeks, and six months for closure, complications, and patient satisfaction. Clinical assessment of each patient was conducted at one year and then at yearly intervals for patient satisfaction. Results Post-procedure pain ( p < 0.0001) and objective post-procedure bruising ( p = 0.0114) were significantly lower in the radiofrequency ablation group. Improvements in venous clinical severity score were noted through six months in both groups (endovenous laser ablation 6.6 to 1; radiofrequency ablation 6.2 to 1) with no significant difference in venous clinical severity score ( p = 0.4066) or measured adverse effects; 89 endovenous laser ablation and 87 radiofrequency patients were interviewed at least 12 months out with a mean long-term follow-up of 44 and 42 months ( p = 0.1096), respectively. There were four treatment failures in each group, and every case was correctable with further treatment. Overall, there were no significant differences with regard to patient satisfaction between radiofrequency ablation and endovenous laser ablation ( p = 0.3009). There were no cases of deep venous thrombosis in either group at any time during this study. Conclusions Radiofrequency ablation and endovenous laser ablation are highly effective and safe from both anatomic and clinical standpoints over a multi-year period and neither modality achieved superiority over the other.

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