Microwave versus endovenous laser in great saphenous vein ablation: a randomized controlled clinical study

Abstract

Due to the global burden of varicose veins (VVs) and the impact on the quality of life (QoL) of patients, it is essential to search for better treatment modalities. The main objective of this research was to compare the efficacy, safety, and impact on the QoL of endovenous microwave ablation (EMA) and endovenous laser ablation (EVLA) for the management of varicose veins of the great saphenous vein (GSV). A comparative, multicenter, single-blinded, parallel randomized controlled study conducted on 340 patients confirmed to have primary VVs of the GSV who were further randomized into two groups. The study group (n=170) received EMA, and the control group (n=170) received EVLA. Both the study group and the control group were comparable with regard to their baseline characteristics (P values > 0.05). The study group and the control group were comparable with regard to the limb affected (P=0.184). Only 14.7% and 10.0% of the study group and the control group have both limbs affected. Both the study group and the control group were comparable with regard to CEAP classification (P=0. 068). The study group and the control group were significantly different with regard to operating time (P<0.001). The operating time is less in the study group than in the control group. The median (IQR) and the mean±SD of the operating time was 7 (4) and 8.7±4.1 min in the study (microwave) group and 9 (5) and 10±3.9 min in the control group. Also, the study group and the control group showed 100% success at the 1-week evaluation as none of the cases in both groups suffered recanalization. At 6-month evaluation, only 1 case in the study group and 2 cases of the control group experienced recanalization; however, the difference is not significant (P=0.537). At the 12-month evaluation, the study group and the control group showed 100% success as none of the cases in both groups suffered recanalization. QoL is better in the study group than the control group at 6 months Aberdeen score (P=< 0.001). The median IQR and the mean±SD of the postoperative Aberdeen score were 9 (2.7) and 9.3±1.7 in the study (microwave) group and 10.8 (3.4) and 10.8±1.8 in the control group. Moreover, the study group and the control group were comparable (P values > 0.05) with regard to adverse events except for paresthesia (P-value = 0.025). About 11.2% of the control group experienced paresthesia versus only 2.9% of the study group. In conclusion, EMA has a lower operating time than EVLA. EMA is as effective as EVLA for treating VVS of the GSV. EMA has fewer adverse events than EVLA. EMA has better QoL than EVLA ablation. However, the choice of treatment should be based on individual patient characteristics and the expertise of the treating physician.