Surgery vs. Laser Treatment for Varicose Veins

Sept. 19, 2011 -- A newer, less-invasive technique that uses a laser to seal off bulging and uncomfortable varicose veins appears to work about as well as the standard surgery to remove the damaged vessels, a new study shows.

Neither procedure appears to be a guaranteed permanent fix for varicose veins, however.

Veins can grow back even after they're cut away, and sometimes the laser treatment fails to seal a vein completely, allowing the blood flow to gradually return.

Study researchers say patients should carefully weigh the benefits and risks with their doctors before deciding on the best treatment strategy.

The study is published in the Archives of Dermatology.

Vein Stripping vs. Laser Ablation

The study followed 346 men and women with varicose veins. They were randomly assigned to receive a standard surgical procedure called high ligation and saphenous vein stripping (HLS) or endovenous laser ablation (EVLT). 

There were 185 people in the EVLT group and 161 in the HLS group. About 70% in each group were women. Their average age was 48.

After two years, the overall recurrence of varicose veins that caused symptoms like pain, heaviness, swelling, itching, or fatigue was similar among the two groups. By ultrasound study, more patients who had EVLT had their varicose veins return or reopen at the location of the procedure compared to those who had vein stripping surgery, however.

In the EVLT group, 32 people (18%) had their varicose veins come back in the area at the same place where they were originally treated compared to two people (1%) of the HLS group.

"The main implication of our study at this time point is that both procedures can be equally offered to the patients with [varicose veins]," says study researcher Knuth Rass, MD, a dermatologist at Saarland University Hospital in Homburg, Germany, in an email to WebMD. "But patients should be informed that there might be a risk for a higher rate of clinical recurrences beyond two years after EVLT."

Rass continues to follow the patients in the study and says he will know more about their longer-term recurrence rates next year.

Cost of Treatment

The cost of vein stripping surgery ranges from $1,500 to $3,000 plus fees charged by the hospital or surgical center. Costs for EVLT range from $600 to $3,000, depending on how much of the vein needs to be treated.  Insurance may pick up part of the tab, however, if the varicose veins are painful or debilitating.

Against expectations, researchers found that patients in the EVLT group had slightly more pain in the first week after their procedures compared to those who had vein stripping surgery, but it went away more quickly, too.

Patients in the EVLT group reported having pain for an average of eight days after their procedures compared to 17 days in the HLS group.

The EVLT group also experienced more skin discoloration after their procedures.