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Title: The endovascular treatment of varicose veins : a prospective double-blind randomized controlled trial of radiofrequency versus laser ablation of great saphenous varicose veins
Author: Brar , Ranjeet
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2013
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Chronic superficial venous insufficiency (CSVI) of the lower limb - commonly termed varicose veins (VV) - is a common and potentially debilitating condition, affecting between one third and two fifths of men and women in Britain. Traditional open dperative techniques are effective and have remained the definitive treatment modality, but modern endovascular techniques, introduced over the last decade, are increasingly perceived to confer the benefits of decreased operative time, invasiveness, patient discomfort and recovery time, making them attractive to clinicians and patients alike. Attempts to gauge the available evidence to support this incipient change in practice prompted us to undertake a systematic review and meta-analysis of all studies reported in the literature that provide objective data regarding the efficacy of open surgery and the principal endovascular techniques - radiofrequency ablation (RP A) and endovenous laser therapy (EVL T). Most published data relate to chronic venous insufficiency caused by primary great saphenous vein reflux, which is commonly encountered, and therefore an appropriate model from which to draw conclusions on treatment efficacy. The results of this study show that endovascular techniques have already achieved outcomes at least equivalent to open surgery. This has principally been quantified by duplex ultrasound measured occlusion of the primary refluxing vems. Published data, when pooled, also suggest lower complication rates with endovascular varicose vein ablation. The relative efficacy and merits of RP A and EVL T were not addressed in the literature at the commencement of our enquiry. Most published studies compare one or other of these endovenous ablation technologies with open surgery. This dearth of clinical data prompted me to set up a prospective double-blind randomized controlled trial (RCT), to investigate the null hypothesis, that "there is no difference in the efficacy of radiofrequency ablation and endovenous laser therapy for the treatment of primary great saphenous territory varicose veins ". The results of the endovascular varicose vein EVLT or RFA treatment trial (EVVERT study, ISRCTN 63135694) comprise the main body of results within this thesis. Our study confirmed that both EVL T and VNUS ClosureF AST (the latest, most efficacious, and now widespread method of RF A) are highly effective, achieving 100% occlusion as measured by duplex ultrasound one-week post-operatively. Significantly less post-operative pain and bruising was experienced among patients ;1 undergoing RFA, however (P = 0.001). At three months the occlusion rates were 97% for RF A and 96% for EVLT respectively (P = 0.67). Quality of life in both groups demonstrated a similar (P = 0.12) improvement at 3 months follow-up, with mean (± SD) reduction in A VVSS scores in the EVLT group of 1 1.2 (±8.9), while for the RP A treated patients symptom score improvement was 10.3 (±6.8), confirming the overall benefit of both procedures. Given published long term (ten year) VV recurrence rates of 60 percent following open surgery, further long term follow up data would ideally be gathered from the participants of the trial, although we note the difficulties in collecting such data from a young and mobile patient population.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.M.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available