Challenges in the management of primary lower extremity varicose veins: what is the best treatment option?

Background
Varicose vein is considered as one of the commonly practiced venous problems for decades not only by vascular surgeons but also by general surgeons.
Aim
The purpose of the current study was to compare the results of management of lower limb superficial varicosities using conventional surgery versus endovenous laser ablation (EVLA) therapy.
Patients and methods
A retrospective study took place in the period of three years from January 2015 until December 2017. Patients were selected for having reflux of the great saphenous vein (GSV) with primary varicosities of the lower limb presenting to the vascular surgery clinic. Patients were divided into two groups: group I included those who were treated with GSV short stripping and saphenofemoral junction disconnection, whereas group II involved patients who underwent EVLA.
Results
The study included 80 patients. There were 50 females and 30 males, with a female to male ratio of 5 : 3. Patients’ age ranged from 22 to 44 years, with a median age of 34 years. There was a significantly higher initial technical success rate of 95% (=38) in the group treated with EVLA versus 90% (=36) in the group treated surgically (=0 · 006). Operative outcome was statistically significantly higher in the group treated with EVLA compared with the surgically treated group (=0.002). A significant difference between operative procedures versus operative outcome was seen (=0.002). Recurrent varicosities were observed in 10% and 5% in group I and group II, respectively. Heat-induced deep vein thrombosis was reported in 2.5% of cases.
Conclusion
Treatment of superficial varicosities with EVLA had a lower incidence recurrence rate than traditional surgery in the short-term follow-up. Moreover, the minimally invasive EVLA therapy, especially, in female patients seems to be a highly effective and safe modality for treatment of primary GSV varicosities.