Combined stab high ligation with retrograde laser ablation compared to endovenous laser ablation in the treatment of symptomatic great saphenous varicose veins

Objective
To compare reflux recurrences and complications after combined stab high ligation and retrograde laser ablation (SHL/ablation) with endovenous laser ablation (EVLA) of the great saphenous vein (GSV) varicosity.
Patients and methods
This study was designed as a single-center, nonblinded, randomized controlled trial; patients with symptomatic primary GSV varicosity with an incompetent saphenofemoral junction (SFJ) were randomized into two groups: the first was treated by high ligation of GSV with SHL/ablation and the second group was treated by EVLA, both groups received laser therapy using 120 J/cm of 980 nm diode laser. Patients with bilateral GSV insufficiency were randomized separately for each leg. The primary outcome was anatomic success with complete obliteration of the GSV. Secondary outcomes were sonographically determined reflux and clinical recurrence in the treated area after 1 year.
Results
Between March 2014 and December 2016, 280 legs in 257 patients were treated by SHL/ablation (=140) or EVLA (=140). The mean age, preoperative complain, mean GSV diameter, and treated length were comparable in both groups. There were no significant differences in postoperative complications or pain experience during or after the procedure in both treatments. The procedure time was significantly longer in SHL/ablation group (88.5±9.8 min) than EVLA (66.5±11.76 min). Twelve months after procedures, SHL/ablation limbs had no recurrence of clinical complaints or venous reflux while EVLA limbs showed venous reflux in 17 (12.1%) limbs and recurrence of limb edema and heaviness in 15 (10.7%) limbs with significant difference between the two groups (0.05).
Conclusion
Combined high ligation through stab incision with laser ablation of GSV significantly decreases the risk of venous reflux and clinical recurrence after treatment of GSV varicosities.