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Ten-year outcomes of a randomized clinical trial of endothermal ablation versus conventional surgery for great saphenous varicose veins

Lookup NU author(s): Dr Sandip NandhraORCiD

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Abstract

© The Author(s) 2024. Background: Surgical ligation and stripping (surgery) and endothermal ablation are both effective treatments for varicose veins, improving quality of life (QoL) up to 5 years. Few data are available on long-term outcomes. The aim of this study was to evaluate the outcomes 10 years after interventions in an RCT. Previously this RCT demonstrated that endothermal ablation is associated with superior postprocedural QoL, more rapid recovery, and lower rates of early clinical recurrence. This analysis reports outcomes at 10 years. Methods: Patients with symptomatic varicose veins owing to unilateral great saphenous vein reflux were randomized to either surgery or endovenous laser ablation (EVLA). Outcomes at 10 years included clinical recurrence and QoL. Results: Data were obtained for 206 of 280 patients (73.6%) at 10 years. Both groups retained significant QoL improvement compared with pretreatment levels (Aberdeen Varicose Vein Questionnaire (AVVQ), Short Form 36 (SF-36®), and EQ-5D™; P < 0.001). Clinical disease progression from baseline was observed in only 10.7% of patients. The clinical recurrence rate was lower in the EVLA group (37 versus 59%; P = 0.005). The number needed to treat with EVLA to avoid one clinical recurrence within 10 years was five. This was associated with significantly higher (better) generic QoL scores with EVLA in several SF-36® domains, including bodily pain (median 84 (i.q.r. 51–100) versus 62 (41–84); P = 0.009) and general health (77 (62–87) versus 67 (52–82); P = 0.017). AVVQ scores in the EVLA group were also lower (better) (3.1 (0–7.7) versus 6.3 (0.7–13.3); P = 0.029). Conclusion: Both surgery and endothermal ablation are effective treatments for varicose veins at 10 years, with durable improvement in QoL and a very low rate of disease progression. However, endothermal ablation was associated with superior clinical and QoL outcomes. Registration number: NCT00759434 (http://www.clinicaltrials.gov).

Publication metadata

Author(s): Mohamed AH, Howitt A, Rae S, Cai PL, Hitchman L, Wallace T, Nandhra S, Pymer S, Knighton A, Smith G, Chetter IC, Carradice D

Publication type: Article

Publication status: Published

Journal: British Journal of Surgery

Year: 2024

Volume: 111

Issue: 8

Online publication date: 20/08/2024

Acceptance date: 05/07/2024

ISSN (print): 0007-1323

ISSN (electronic): 1365-2168

Publisher: Oxford University Press

URL: https://doi.org/10.1093/bjs/znae195

DOI: 10.1093/bjs/znae195

PubMed id: 39162334

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