Laser for varicose veins no better than surgery

NEW YORK (Reuters Health) - Laser therapy doesn't appear to outshine the standard surgery to treat severe varicose veins, new research suggests.

In the largest study so far to compare the two procedures, doctors found no significant differences in the number of patients who went on to develop new varicose veins two years after treatment.

Varicose veins are relatively common, but the precise estimates vary widely -- from five to 30 percent of adults. Usually they don't cause any problems, but in a small percentage of people they can be severe enough to cause pain and swelling, and even wounds or blood clots in rare instances.

In the less serious cases, exercise, weight loss and compression stockings may ease pain and prevent the varicose veins from getting worse.

For severe cases, however, the standard treatment is to remove the vein with surgery -- also known as high ligation and saphenous vein stripping. Costs vary, but start at a few hundred dollars.

While the procedure is considered safe and effective, a considerable number of patients end up having new varicose veins caused by regrowth of blood vessels.

Laser treatment, also called endovenous laser ablation, is an alternative procedure in which a small probe is inserted into the vein and causes it to collapse and disappear. It is less invasive than surgery and has become increasingly popular, although it is more expensive.

Yet only a few small experiments have compared laser treatment to surgery. So Dr. Knuth Rass of the Saarland University Hospital in Homburg, Germany, and colleagues assigned 400 patients to one of the two procedures.

All patients had been diagnosed with "chronic venous insufficiency" of the great saphenous vein, which runs from the hip to the toes.

Of the 316 patients who could be reached by the researchers two years later, 16 percent of the patients who got laser treatment had developed new varicose veins.

That figure was 23 percent in the surgery group, but the difference was small enough that it might have been due to chance, the researchers report in the Archives of Dermatology.

Although patients in the laser group were slightly happier with the cosmetic results of their procedure than those in the surgery group, they were much more likely to experience a backflow of blood where the saphenous vein connects with the femoral vein.

Based on ultrasound scans, the researchers were surprised to see that about 18 percent of the patients in the laser group had that problem, compared to just one percent of those who had surgery.

While backflow in a vein may lead to bulging varicose veins in the future, Rass and colleagues stress that they can't say for certain and recommend more research in the area.

There were also some differences in side effects, with more laser patients experiencing swelling caused by blood clots, pain after the procedure and skin color changes. On the other hand, surgery patients took about a day and a half longer to return to work.

All in all, the researchers conclude, the two treatments seemed equally effective, and 98 percent of all patients said they would undergo each procedure again if medically necessary.

Alternative treatments for severe varicose veins include sclerotherapy, in which a chemical in injected into the vein causing it to die, and ambulatory phlebectomy, in which smaller varicose veins are removed through several tiny skin punctures.

SOURCE: http://bit.ly/pkVTzD Archives of Dermatology, online September 19, 2011.