The Endovenous Laser Ablation (EVLA) and Traditional Vein Stripping (TVS) for the Treatment of Varicose Veins in Forearm: a Comparative Analysis

Background: Varicosis is a common venous condition, which is typically treated surgically. However, selection of the optimal surgical approach can be challenging. It is far more common to experience varicose veins, or spider veins, in your legs; many people do suffer from varicose veins in their arms. Luckily, there are treatment modalities available that have proven to be extremely effective and have minimal side effects. In this, randomized controlled trial, the endovenous laser ablation (EVLA) was compared with conventional surgery with stripping for the treatment of varicose veins of forearm. Aim and objectives: Compared the preoperative and postoperative outcomes of EVLA and Traditional surgery with vein stripping (TVS) in the patients with vein varicosis in forearm. Materials and Methods: The present study was a single‐center, prospective comparative study conducted on patients admitted with varicose veins in the surgical wards of Hind Institute of Medical Sciences and Hospital, Ataria, Sitapur, UP. From March 2022 to August 2023. A total of 56 varicose veins patients admitted in ward were divided into the two groups of 28 patients in each group who underwent EVLA or TVS surgery as per patients consent. Patients were included in this study based on the inclusion and the exclusion criteria. Result: A total of 56 patients were divided into the EVLA group (n=28; 20 males, 8 females) and the TVS group (n=28; 22 males, 6 females). The mean age of the patients was 42.21± 10.24 years in the EVLA group and 41.9± 9.31 years in the TVA group (P =0.788). The left arm was affected in 71.42 % of the EVLA group and 64.28% of the TVS group (P =0.640). According to AVVSS (Aberdeen varicose vein symptom severity), in the EVLA group was 4.7±3.1 and 4.8± 2.7 in the TVS group, the differences were also found significant at 6, 12 and 24 hours (P=0.05). Pain severity in 6, 12 and 24 hours after the procedures were significantly different between the two groups. The pain severity score was found more in TVS group as compared to EVLA; at 24 hours it was 6.58 ±1.026, in TVS; whereas 4.17 ± 1.011 in EVLA. (p=0.05). Chronic pain (seventh day, 3, 6, and 12 months after the procedures) was present 14.28% in EVLA group and 25% in TVA group. It was found significant (P ≤0.05). According to NRS, the mean chronic pain severity in the EVLA group was 3.50 ± 0.657 and 5.99 ± 0.754 in the TVA group, and the difference was significant (P= 0.05). The length of the operation was 41.3±10.6 minutes in the EVLA group and 52.3±11.8 minutes in the TVA group that was also found significant (P=0.14). At 3 months, the recurrence rate of the EVLA and TVA groups was 3.5 and 6.7% respectively. The Post‐VDS score was significantly lower in all EVLA patients as compared to TVS. The mean pre–post difference in the VDS scores in TVS was found higher and also found significantly different (EVLA‐0.89±0.14 vs. TVS‐1.33± 0.91, P < 0.01).It was also observed that the return to normal activities (days) was better in EVLA group as compared to TVS, it was 2.1±02 (Days) in EVLA whereas, 3.2± 1.6 in TVA. (p=0.05). Conclusion: The TVS group was the increased incidence of hematoma formation and the movement of arms on the first postoperative day was very painful. The results of this study indicated the higher efficacy of EVLA for upper extremity varicosis treatment as compared to TVS. It has also been observed that the two methods were significantly different in length of procedure, complications, and pain. The cosmetic outcome of TVA method was not acceptable, as the one‐year follow‐up results indicated difference in there recurrence rate and pain with other complications. In this study the sample size was very small. Hence, these findings have to be further validated with large sample size of forearm before concrete recommendations.