N Samuel1, T Wallace, D Carradice, G Smith, F Mazari, I Chetter. 1. Hull York Medical School/University of Hull - Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull HU3 2JZ, UK. nehemiah.samuel@hey.nhs.uk
Abstract
OBJECTIVE: We aimed to assess the evolution of an endovenous laser ablation (EVLA) practice in the management of varicose veins in a university teaching hospital vascular surgical unit, over five years. METHODS: This was a retrospective review of a prospectively collected database of patients undergoing EVLA for great saphenous vein incompetence and followed up for a year. For inter- and intragroup comparison, patients were divided into three groups: group A: endovenous access generally established at the perigenicular level (n = 105); group B: when practice changed to gain access at lowest point of demonstrable reflux (n = 70); and group C: when tumescence delivery changed from manual injections to delivery via peristaltic pump (n = 49). Outcomes including pain scores, time taken to return to normal functioning, quality of life (QoL), venous clinical severity scores (VCSS) and complication rates were evaluated. RESULTS: Intergroup analysis: increase in the length of vein treated and laser density delivered was observed over time, even as median procedure duration decreased (P < 0.001). An increase in sensory disturbance was noticed in group C (P = 0.047) while better Aberdeen Varicose Vein Questionnaire (AVVQ) (P = 0.004), SF-36(®) physical domains (P < 0.05) and patient satisfaction with treatment (P = 0.025) were recorded in the same group at 52 weeks. No significant difference was observed in technical failure, pain scores, return to normal functioning, VCSS and recurrence rates post-intervention. Intragroup analysis: QoL measures (AVVQ, SF-36(®), EQ-5D) and VCSS scores demonstrated significant improvement at 12 and 52 weeks compared with baseline (P < 0.05). CONCLUSIONS: Increase in length of vein treated and energy delivery seems to improve short-term outcomes; however, operators need to be wary of a possible concurrent increase in paraesthetic complications.
OBJECTIVE: We aimed to assess the evolution of an endovenous laser ablation (EVLA) practice in the management of varicose veins in a university teaching hospital vascular surgical unit, over five years. METHODS: This was a retrospective review of a prospectively collected database of patients undergoing EVLA for great saphenous vein incompetence and followed up for a year. For inter- and intragroup comparison, patients were divided into three groups: group A: endovenous access generally established at the perigenicular level (n = 105); group B: when practice changed to gain access at lowest point of demonstrable reflux (n = 70); and group C: when tumescence delivery changed from manual injections to delivery via peristaltic pump (n = 49). Outcomes including pain scores, time taken to return to normal functioning, quality of life (QoL), venous clinical severity scores (VCSS) and complication rates were evaluated. RESULTS: Intergroup analysis: increase in the length of vein treated and laser density delivered was observed over time, even as median procedure duration decreased (P < 0.001). An increase in sensory disturbance was noticed in group C (P = 0.047) while better Aberdeen Varicose Vein Questionnaire (AVVQ) (P = 0.004), SF-36(®) physical domains (P < 0.05) and patient satisfaction with treatment (P = 0.025) were recorded in the same group at 52 weeks. No significant difference was observed in technical failure, pain scores, return to normal functioning, VCSS and recurrence rates post-intervention. Intragroup analysis: QoL measures (AVVQ, SF-36(®), EQ-5D) and VCSS scores demonstrated significant improvement at 12 and 52 weeks compared with baseline (P < 0.05). CONCLUSIONS: Increase in length of vein treated and energy delivery seems to improve short-term outcomes; however, operators need to be wary of a possible concurrent increase in paraesthetic complications.