Surgery vs Laser Treatment for Varicose Veins

November 12, 2012

Surgery vs Laser Treatment for Varicose Veins

Varicose veins have been suffered by many people over the years. They are uncomfortable, painful and unattractive and give feelings of pain, fatigue, swelling and itchiness. Hence, why treatment to remove varicose veins is commonplace.

A new report, which was published in the medical journal, Archives of Dermatology, states that a new form of treatment is now available. The treatment uses a laser to treat the disfigured veins, and has been found to be at least as successful as the conventional method of treatment. Although like the conventional method, it does not guarantee to repair the varicose veins permanently.

After conventional treatment where veins are cut out, it is not uncommon for those veins to reappear. With laser treatment, if the vein is not sealed totally then blood flow can return with the same effects as previously.

The researchers do not advocate any one particular method over the other one. They say that talking with your doctor before embarking on a particular course of action is best. That way the patient is aware of any risks and benefits related to each choice.

Varicose Veins – Surgery or Laser?

A group of 346 varicose vein sufferers were used in the study. The study went on to assess the outcome of two treatments used to treat varicose veins. The treatments are called high ligation and saphenous vein stripping, also known as HLS, this is the more traditional method. And the second method was the laser technique, known as endovenous laser ablation or EVLT.

The patients were chosen at random for each procedure and 185 people underwent EVLT and the remaining 161 were treated using the HLS technique. The group consisted of about 70% female and 30% male participants and the average age was 48 years.

The patients were followed up two years later and asked to report on their feelings about their varicose veins and they were also given an ultrasound examination. The amount of recurrence of varicose veins between the two treatments was similar. The ultrasound examination revealed that the return of varicose veins at the place where the previous veins were was more common in the EVLT group than in the HLS group.

The EVLT group had 32 people (18%) whose varicose veins returned in the same area where the original treatment took place compared to only two people (1%) in the other group.

The study researcher says that this means, “The main implication of our study at this time point is that both procedures can be equally offered to the patients with [varicose veins]“. The researcher is Knuth Rass, MD, a dermatologist at Saarland University Hospital in Homburg, Germany, and he goes on, “But patients should be informed that there might be a risk for a higher rate of clinical recurrences beyond two years after EVLT”.

He further points out that the study is not yet complete and he will continue to follow up the patients to gain further long term information.

Costs Involved with Removing Varicose Veins

In countries where payment is necessary for treatment the costs for HLS, the vein stripping surgery run slightly higher than between $1,500 and $3,000 when extras are included. The EVLT, laser treatment starts a bit cheaper at $600 but can also cost as much as $3,000 in certain cases depending on the severity of the varicose veins. However, in cases where there is a lot of pain and the veins are affecting your lifestyle then health insurance may pay.

The researchers expected the EVLT procedure to be less painful but found the opposite was true after interviewing the patients. However the pain did go away sooner than in the other vein stripping group. The EVLT patients were recorded as having pain for eight days, on average, whereas the vein stripping, HLS group reported pain for seventeen days, on average.

Bruising and skin discoloration was more prevalent in the EVLT group too after the procedures were carried out.

Weighing Up your Options

Tristan R.A. Lane, MBBS, a vascular surgeon at Charing Cross Hospital and a researcher at Imperial College London was not involved in the study but reviewed the research and comments that, “This is an interesting paper, and gives a very similar picture that most other studies have shown”. Lane says that this study reinforces earlier studies findings by saying, “The overall message, as has become clear from most studies, is that the differing methods of vein treatment all work and provide good treatment if done well”.

Lane also points out that advances in technology means that the study compared patients being operated on using an older type of laser technique. He asserts that newer technology is producing better results. He has also identified an issue where the patients in the HLS, vein stripping group in the study were given, what he considers to be a superior type of anesthetic, called tumescent local anesthesia. He believes that perhaps the results for this group are better than for a group using the standard type of anesthesia.

He sums up by saying that what he has read will not change what he says to his patients. Presently he tells us that, “I usually explain that endovenous laser ablation [EVLT] provides a very good option, allowing patients to walk out of the clinic and go back to work the same or next day. I also explain that one treatment does not fit all and so we always consider other treatment methods”.

This view is held by the researchers too and they expand that perhaps for younger patients the EVLT technique is best. This is because some other research has indicated that after EVLT any repairs to varicose veins are easier than after HLS and the younger the patient then the more likely it is that more surgery will be required.

Rass goes on to say that for mature patients and those with larger veins or more difficult to repair veins it appears that vein stripping is best. However he accepts that this point of view requires more research to confirm the benefits of each technique.

He concludes by explaining, “It will be the task for the future for us to characterize those patients having a risk for reopening and early clinical recurrence. This would help a lot to recommend the procedure with the best success for an individual patient”.

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