A Comparison of Concomitant Tributary Laser Ablation and Foam Sclerotherapy in Patients Undergoing Truncal Endovenous Laser Ablation for Lower Lime Varicose Veins
A prospective non randomized controlled study comparing the efficacy and safety of simultaneous tributary vein ablation with either Foam Sclerotherapy (FS) or Endovenous Laser ablation(EVLA) while performing EVLA of the greater saphenous vein was conducted. 418 patients were enrolled (CEAP score between 2 and 6), 163 underwent tributary vein EVLA at 8 Watts while 255 underwent FS with 3% Polidoconol using the Tessari technique. Outcomes were measured at 3 days, 4 weeks and 6 months using the Aberdeen Varicose Vein Questionnaire(AVVQ), EuroQol Group 5(EQ-5D) and Numerical rating scale for pain. At 4 weeks and 6 months respectively, the EVLA group exhibited poorer QoL than the FS group (P<0.001 for AVVQ ;P<0.01 for EQ-5D) and (P<0.5 for AVVQ; P<0.05 for EQ-5D). At 6 months the FS group had lower (4.9%) visible varicosities than the EVLA group (21.6%). FS group reported significantly higher post procedural pain only at 4 weeks (P<0.001. Persistent ecchymosis, pigmentation and local induration were significantly higher in the FS group at both 4 weeks and 6 months (9.3%vs 6.2%). The authors concluded that concomitant tributary ablation with FS during truncal laser ablation of the GSV is more efficacious and improves Qol compared to EVLA.
This paper evaluates the utility of concomitant treatment of tributary veins using 2 different techniques. Advantage of simultaneously treating tributary varicosities include lesser cost and reduced need for a second procedure. Simultaneous treatment is associate with longer procedure time and post-procedure discomfort. Supported by recent randomized studies favoring simultaneous treatment, the National Institute for Health and Care Excellence has set simultaneous tributary vein treatment as the standard of care. Phlebectomy is more invasive than EVLA and FS. Based on the paper, the treatment of choice for tributary veins appears to be FS.
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Wang JC, Li Y, Li GY, et al. A Comparison of Concomitant Tributary Laser Ablation and Foam Sclerotherapy in Patients Undergoing Truncal Endovenous Laser Ablation for Lower Limb Varicose Veins. J Vasc Interv Radiol 2018; 29:781-9.
Anil K Pillai, MD
Associate Professor and Section Chief,
University of Texas Health Science Center, Houston, TX 77030