Quality-Time spent Without Symptoms or Toxicity (Q-TWiST) and cost-effectiveness of Endovenous Laser therapy (EVLT) Vs conventional level II sapheno-femoral junction ligation (SFJ) and LSV Stripping (OLS) for primary Varicose Veins (VVS). A prospective Pivotal Study.

OBJECTIVES:
There is a paucity of data on EVLT incidence of post-operative pain, phlegmon and re-canalization. Our aim is to equate saphenous closure rates, complications and cost-effectiveness of EVLT and stab avulsion with conventional level II SFJ, OLS and stab avulsion.
METHODS:
From 2003 to 2007, of 756 consecutive VVS procedures, we matched controlled 257 patients with primary VVs; CEAP 2,3,4. 193 had OLS under spinal anaesthesia [70%female; mean age (+/-SD)=51+/-14yrs] and 64 had EVLT under local anaesthesia [88%female; mean age(+/-SD)=50+/-11yrs]. Major adverse events (MAE), Quality-Time spent Without Symptoms or Toxicity (Q-TWiST) and cost-effectiveness were analysed. Venous clinical severity (VCSS), segmental disease (VSDS) and disability (VDS) scores were compared but all were statistically similar (P>0.05).
RESULTS:
Mean follow-up was 20+/-8.7months and LSV closure rate with EVLT was 84.3% (+/-SE9.06%, P=0.061). Mean length of stay was lower with EVLT [6hrs(Range4-12hrs) vs.14hrs(Range6-36hrs), p<0.0001]. There was one incidence of wound infection with OLS (0.5%, p=0.75). There were eight cases of severe post-operative pain in the EVLT group (12.5%, p= 0.00001) and two cases of phlegmonous phlebitis (3%, p=0.061). All cases resolved .
Using Cox-proportional hazard ratios the factors found to influence rate of MAE with EVLT was type of laser probe, Length of LSV and Acetyl salicylic acid consumption (P=0.005).
Q-TWiST was longer in the OLS group (21.3months vs. 15.13months, p<0.001) but there was a 30% reduction in mean cost per QALY with EVLT.
CONCLUSIONS:
EVLT is a safe prudent effectual procedure however; post-operative thermal injury pain is the foremost constraining dynamic factor with contemporary laser probes.