Ten-year data from the randomised HELP trial show that, while both endothermal ablation and conventional surgery are effective treatments for great saphenous varicose veins at 10 years, the former was associated with superior clinical and quality-of-life (QoL) outcomes. These findings have been published in the British Journal of Surgery (BJS).
First author Abduraheem H Mohamed, senior author Daniel Carradice (both Hull University Teaching Hospitals and Hull York Medical School, Hull, UK) and colleagues write that both endothermal ablation and surgical ligation and stripping, i.e. surgery, are both effective treatment for varicose veins, improving QoL up to five years. However, they note that few data are available on long-term outcomes.
The aim of the HELP trial, Mohamed et al state, was to evaluate the outcomes of both endothermal ablation and surgery 10 years after interventions in a randomised controlled trial (RCT).
Previously, the authors share, their RCT demonstrated that endothermal ablation is associated with superior postprocedural QoL, more rapid recovery, and lower rates of early clinical recurrence. Their most recent analysis reports outcomes out to 10 years.
In their methods section, Mohamed and colleagues detail that patients with symptomatic varicose veins owing to unilateral great saphenous vein reflux were randomised to either endovenous laser ablation (EVLA) or surgery. They specify that outcomes at 10 years included clinical recurrence and QoL.
The investigators report that they obtained data for 206 of a total of 280 patients (73.6%) at 10 years.
In BJS, Mohamed et al reveal that both the EVLA and surgery groups retained significant QoL improvement compared with pretreatment levels, as assessed by the Aberdeen Varicose Vein Questionnaire (AVVQ), Short Form 36 (SF-36) and EQ-5D, with a p value of less than 0.001.
They continue that clinical disease progression from baseline was observed in only 10.7% of patients and that the clinical recurrence rate was lower in the EVLA group (37 vs. 59%; p=0.005), with the number needed to treat with EVLA to avoid one clinical recurrence within 10 years being five. This, the authors write, was associated with significantly higher (better) generic QoL scores with EVLA in several SF-36 domains, including bodily pain—median 84 (interquartile range [IQR], 51–100) vs. 62 (IQR, 41–84); p=0.009)—and general health, at 77 (IQR, 62–87) vs. 67 (IQR, 52–82); p=0.017. In addition, AVVQ scores in the EVLA group were also lower (better), at 3.1 (IQR, 0–7.7) vs. 6.3 (IQR, 0.7–13.3); p=0.029).
