Endovenous Laser Ablation with 1,470-nm Diode with Tumescence Anesthesia and Saphenofemoral Ligation: Propensity Score Match Comparison

Autor: Marco Ventura, Vincenza Cofini, Angelica Dante, Alessia Salerno, Stefano Necozione, Marco Leopardi
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Adult
Male
medicine.medical_specialty
Time Factors
Databases
Factual
Ecchymosis
030204 cardiovascular system & hematology
Risk Assessment
030218 nuclear medicine & medical imaging
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Recurrence
Risk Factors
Varicose veins
Humans
Medicine
Saphenous Vein
Propensity Score
Ligation
Aged
Retrospective Studies
Tumescent anesthesia
Surgery
Cardiology and Cardiovascular Medicine
Groin
business.industry
Endovascular Procedures
Great saphenous vein
Ultrasonography
Doppler
Retrospective cohort study
General Medicine
Odds ratio
Femoral Vein
Middle Aged
Treatment Outcome
medicine.anatomical_structure
Venous Insufficiency
Propensity score matching
Quality of Life
Female
Laser Therapy
Lasers
Semiconductor
medicine.symptom
business
Anesthesia
Local
Popis: Background The aim of this study is to compare 2 groups of patients treated for great saphenous vein (GSV) reflux with open surgical saphenofemoral ligation (SFL) and endovenous laser ablation (EVLA). Methods Consecutive patients with primary unilateral GSV reflux undergoing EVLA treatment since 2014 were enrolled, and another series of patients treated with SFL was considered. The patients were stratified according to treatment and the results were compared using the propensity score (1:1). The covariables were age, gender, body mass index, CEAP (Clinical class, Etiology, Anatomy and Pathophysiology) staging, and GSV and saphenofemoral junction diameters. Primary outcomes were GSV occlusion or recurrent groin varicose veins at 1 year after treatment. Secondary outcomes included vein thrombosis, hyperpigmentation, paresthesia, postoperative pain, analgesic requirement, and ecchymosis assessed at discharge and CEAP stage and quality of life (QoL) assessment 1 month after surgery. Results A total of 123 patients were included in the study: 59 were treated with EVLA and 64 with SFL. At 12 months, we observed 10 recurrent groin varicose veins after SFL (15.6%) and 6 GSV recanalization after EVLA (10.2%, P = 0.369). Extra-saphenous recurrent varicose veins were observed in 36 patients (29.3%): 20 in the open group (31.2%) and 16 in EVLA group (27.1%, P = 0.615). After matching procedure 74 patients were analyzed (37 patients by group), logistic regression model showed that the risk of outcome was not associated with the surgical treatment (odds ratio 1.76, 95% confidence interval 0.52–6.01). Conclusions Both techniques to treat saphenous impairment have demonstrated to be safe, with good results in terms of efficacy and symptomatic improvement at follow-up. EVLA with 1,470 nm seems to have lower rates of recurrence and good perceived QoL. Tumescent anesthesia is a good option with good results and may be extended to open surgical ligation.
Databáze: OpenAIRE
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