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Two Varicose Veins Treatments Equally Effective
Date:9/19/2011

By Steven Reinberg
HealthDay Reporter

MONDAY, Sept. 19 (HealthDay News) -- Although laser treatment and surgery are both effective in treating varicose veins, it appears that recurrence of one form of the problem is more common with the laser treatment, German researchers report.

Varicose veins are twisted and enlarged veins that usually occur in the legs. As many as 35 percent of adults suffer complications from varicose veins, usually when the leg's so-called great saphenous vein becomes blocked, affecting blood flow. Standard treatments include removing the vein either with surgery or a laser procedure, which can prevent complications and improve quality of life, researchers say.

"Our opinion is that both procedures can be equally offered to the patients with great saphenous vein insufficiency," said lead researcher Dr. Knuth Rass, from Saarland University Hospital in Homburg.

However, patients should be informed that there might be a risk for a higher rate of clinical recurrences beyond two years after the laser treatment, he said.

Bulging varicose veins -- often purple and dark blue -- are usually seen in the legs or feet because standing puts more pressure on them. In some people, the problem may simply be cosmetic, but in others it can cause aching and pain, muscle cramping, itching and other symptoms. When accompanied by skin ulcers near the ankle, varicose veins can even signal a serious vascular disease.

The report was published in the Sept. 19 online edition of the Archives of Dermatology.

For the study, Rass and colleagues randomly assigned 346 patients to undergo either a surgical procedure called high ligation and stripping, or a laser treatment called endovenous laser treatment.

The surgical procedure involves tying off the vein, which runs between the hip and the foot, through a small incision at the hip. In the laser procedure, a catheter is inserted into the vein and the laser's burst of light causes the vein to disappear.

During two years of follow-up after the procedure, the researchers looked for recurrence of the condition, severity of the condition, blood flow in the vein and other side effects. They also evaluated how satisfied patients were with each procedure.

Overall, recurrence was 16.2 percent for those who had the laser treatment and 23.1 percent of those who had surgery. But ultrasound revealed that many more patients who had the laser treatment developed one form of the condition called duplex-detected saphenofemoral reflux, where blood flows backward through the vein (17.8 percent of laser treatment patients versus 1.3 percent of surgical patients).

Both treatments equally improved the severity of the disease and the patient's quality of life, and patients were satisfied with both treatments, the researchers noted. "Ninety-eight percent of the study population would undergo each treatment once again, when asked two years after treatment," Rass said.

Although there were more minor side effects with the laser treatment, including pain, it did produce better blood flow in the legs and was associated with faster recovery and a better cosmetic outcome, compared with surgery, the investigators found.

Commenting on the study, Dr. Enrique Ginzburg, a professor of surgery at the University of Miami Miller School of Medicine, said that "it makes sense that the two procedures have similar results."

Ginzburg noted there are other treatments, including radiofrequency-powered segmental thermal ablation and another laser treatment called radial laser fiber, which uses less power, thus reducing pain. There is also a technique that involves a spinning catheter that destroys the inside of the vein causing it to clot off, he said.

For people who have mild cases of varicose veins, experts note, doctors may instead recommend self-care (exercising, losing weight and avoiding tight clothes) or wearing compression stockings to help the blood flow more efficiently.

But there are often medical reasons, not only cosmetic reasons, for having procedures to treat varicose veins, Ginzburg noted. "In reality, it's a combination of both. Varicose veins are painful as they get bigger. At the same time they are unsightly, so it's not just a cosmetic procedure, it's a therapeutic procedure," he said.

Patients are charged about the same for each of these procedures, Ginzburg said. The average cost is about $2,000 whichever procedure a patient opts for, he noted.

As with all surgeries, vein stripping poses some risks, including that of blood clots, infection and nerve damage. Laser procedures for varicose veins also carry a small risk of infection, nerve inflammation and/or damage and blood clots.

Some patients, including pregnant women, should not undergo vein stripping. And as with any surgery, it is also crucial to check the background of the varicose vein specialist beforehand. Experts recommend using a board-certified vascular surgeon.

More information

For more information on varicose veins, visit the U.S. National Library of Medicine.

SOURCES: Knuth Rass, M.D., Saarland University Hospital, Homburg, Germany; Enrique Ginzburg, M.D., professor of surgery, University of Miami Miller School of Medicine; Sept. 19, 2011, Archives of Dermatology, online


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