Authors' objectives: This report evaluates the safety and effectiveness of endovenous laser treatment (EVLT) for varicose veins.

Authors' results and conclusions: Safety: Good quality data were not available to assess the safety of endovenous laser treatment for varicose veins in comparison with vein stripping and ligation. However, all case series assessed in this review did report fully on the outcomes of enrolled EVLT patients. Self-limiting symptoms such as pain, ecchymosis, induration and phlebitis were common adverse events associated with endovenous laser treatment. More serious adverse events such as deep vein thrombosis and incorrect placement of the laser in vessels were uncommon. Deep vein thrombosis occurred in one patient and was an ongoing problem at the end of follow-up, requiring long-term administration of medication. Incorrect laser placement occurred in two patients, ie 0.3 per cent of total limbs treated in the full studies. This serious operator error resulted in no long-term harmful effects; however, the potential for significant damage was real. Paraesthesia, infection, bruising and haematoma were common adverse events associated with stripping of the saphenous vein. The highest paraesthesia rate of 30.3 per cent was reported after ankle to groin surgery at 1 year. The more serious thrombotic adverse events were uncommon, with one pulmonary embolism and superficial venous thrombosis reported in three patients. Although infection was a common adverse event, reported rates within studies were low, ranging from 2 to 8 per cent of limbs. It would appear from the available literature that EVLT is as safe as the current practices of stripping and/or junction ligation. Effectiveness: There were no studies available that assess the effectiveness of endovenous laser treatment for varicose veins in comparison with saphenous vein stripping and junction ligation. From the low-level case series evidence available, it would appear that EVLTTM is of benefit to the majority of patients in the short term. However, the main treatment outcome of abolition of reflux is assessed differently in the two procedures, and is therefore not comparable. Reflux is assessed in the saphenous vein alone after EVLT, but in the entire limb after stripping and junction ligation. In addition, there is confusion regarding the definition of recurrent varicose veins, which may be true recurrent veins, residual incompetent veins or new incompetent veins. Peer reviewed studies have reported the occlusion of saphenous veins and the abolishment of venous reflux in 80 to 100 per cent of limbs treated with EVLT. The study with the longest follow-up period (24 months) reported occlusion of the greater saphenous vein in 93.4 per cent of limbs treated with EVLT. Re-treatment of patients is low, with reported rates between 1.3 and 4.0 per cent; rates for recanalisation are similarly low. Symptoms associated with varicose veins, such as pain and oedema, were reduced after EVLT. Abolition of reflux was observed in 85.9 to 92.2 per cent of limbs that had undergone ankle to groin stripping; and in 57.1 to 100 per cent of limbs that had undergone groin to knee stripping. The study with the longest follow-up period (5 years) reported abolition of reflux in 85.9 per cent of limbs after groin to ankle stripping. Recurrent varicose veins in the absence of reflux were reported at rates of 12.5 to 33.3 per cent after stripping and junction ligation. Whether EVLT is as, or more, effective than the stripping and ligation procedure cannot be determined.

Authors' recommendations: Endovenous laser treatment for varicose veins appears to be safe in comparison to stripping of varicose veins but there is insufficient evidence pertaining to effectiveness and cost-effectiveness, therefore MSAC recommended that public funding should not be supported for this procedure at this time.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.msac.gov.au/reports.htm

Year Published: 2004

URL for published report: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1059-public

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Medical Services Advisory Committee

Contact Address: MSAC (MDP 107), GPO Box 9848, Canberra, ACT 2601, Australia. Tel: +61 2 6289 6811; Fax: +61 2 6289 8799.

Contact Name: msac.secretariat@health.gov.au

Contact Email: msac.secretariat@health.gov.au

Copyright: Medical Services Advisory Committee (MSAC)