Endovenous laser ablation versus ligation plus stripping or sclerotherapy for primary lower limb varicose veins: a multicentric three-arm propensity score matched analysis

Abstract

BACKGROUND AND AIM: Varicose veins (VVs) are one of the most common consequences of chronic venous disease. The present multicentric three-arm study aimed to compare the clinical outcomes of endovenous laser ablation (EVLA) versus ligation plus stripping or sclerotherapy for primary lower limb VVs. PATIENT AND METHODS: The study included 300 patients with VVs. They received EVLA (GI, n = 100), ligation plus stripping (GII, n = 100) or ligation plus sclerotherapy (GIII, n = 100). Groups were matched using propensity score. The primary outcome measures were 1-year total occlusion and recurrence rates. RESULTS: At 1 year follow up, no significant differences were found between the total occlusion rates for GI (75.0%), GII (76.0%) and GIII (83.0%). It was demonstrated that GII had significantly higher recurrence rate (24.0%) as compared to GI (6.0%) and GIII (5.0%). It was also found that GII group had significantly higher frequency of ecchymosis, hematoma and surgical site infection as compared to the other two groups. In contrast, GI had significantly higher frequency of skin ulceration/burn as compared to the other two groups. Also, it was found that GIII had significantly lower frequency of deep vein thrombosis than GI and GII. CONCLUSION: Ligation plus sclerotherapy achieved slightly better total occlusion rate in comparison to EVLA and ligation plus stripping while avoiding important side effects related to them mainly traumatic and thermal injury effects and recurrence.