Comparative study between great saphenous vein endovenous laser ablation and modified hemodynamic correction (conservative hemodynamic correction of venous insufficiency) as a treatment for varicose veins

Background
Varicose veins could be a complicated condition, which may lead to limb swelling, pain, and venous ulcer. Conservative hemodynamic correction of venous insufficiency (CHIVA) has been developed through the past two decades and is currently the second most common surgical procedure for the operative treatment of varicose veins. Endovenous laser treatment of great saphenous vein was approved by FDA in 2002 and short saphenous vein (SSV) was approved in 2003. Endovenous laser ablation (EVLA) is a clinically safe, feasible, and well-tolerated technique without scar and allows people to return to their normal daily activities rapidly.
Patients and methods
In a prospective comparative study between January 2018 and January 2020, 40 patients complaining of varicose veins were assessed according to the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification and ultrasonic duplex and arranged into group I (CHIVA) and group II (EVLA). Both CHIVA operation and EVLA were performed under local anesthesia. Follow-up for 6 months was done.
Results
Recurrence occurred in 2/20 and 0/20 patients in CHIVA and EVLA groups, respectively. Regarding the aesthetic satisfaction of the patient, EVLA was better, with two unsatisfied patients in EVLA in contrast to five unsatisfied patients in CHIVA. The wound infection rate was 1/20 and 0/20 in CHIVA and EVLA, respectively. CHIVA is favored over EVLA considering the rest of the complications. Bruises, thrombosis, and nerve damage are found to be 5/20, 0/20, and 0/20, respectively, in CHIVA group when compared with the results of EVLA group, which were 9/20, 1/20, and 2/20, respectively.
Conclusion
CHIVA is safe, effective, and less invasive. EVLA is now considered as one of the top technologies to be used in the management of varicose veins with good functional outcome. EVLA can be done as an outpatient procedure. Each type of these interventions should be tailored according to each patient’s variables such as degree of reflux in great saphenous vein, presence of incompetent perforators, and aesthetic requirements of the patient.