Published online Dec 16, 2023. doi: 10.12998/wjcc.v11.i35.8291
Peer-review started: September 27, 2023
First decision: October 9, 2023
Revised: October 22, 2023
Accepted: November 30, 2023
Article in press: November 30, 2023
Published online: December 16, 2023
Processing time: 78 Days and 2.7 Hours
Varicosis is a common venous condition, which is typically treated surgically. However, selection of the optimal surgical approach can be challenging. Previous studies comparing endovenous laser treatment (EVLT) and conventional surgery were retrospective and observational in nature and the results may therefore have been influenced by selection bias and the presence of other confounding factors. In this study, we used propensity score matching to reduce selection bias when comparing EVLT and conventional surgery for the treatment of varicose great saphenous veins.
To compare the perioperative and postoperative outcomes of EVLT and conventional surgery in patients with great saphenous vein varicosis.
We retrospectively reviewed the records of 1063 patients treated for primary varicosis of the great saphenous vein at the Second Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2019. Among them, 56 patients were excluded owing to additional small saphenous varicose vein involvement, 81 owing to recurring varicose veins, 83 owing to complicated varicose veins (CEAP clinical classification C5-C6), and 6 owing to perioperative phlebitis. Finally, 772 patients were enrolled in this study. Standard demographic and clinicopathological data were collected from the medical records of the patients. For propensity score matching, 522 patients (261 who underwent EVLT and 261 who underwent conventional surgery) were randomly matched 1:1 by age, sex, onset time, smoking status, presence of diabetes, family history, stress therapy, C class, and the affected leg.
Of the 772 patients included in the study, 467 underwent EVLT and 305 underwent conventional surgery. There were significant differences in age, onset time, smoking and diabetes status, and family history between the two groups. Following propensity score matching, no significant differences in patients’ characteristics remained between the two groups. ELVT was associated with a shorter operation time and hospital stay than conventional surgery, both before and after propensity score matching. There were no differences in complications between the two groups after propensity score matching. Patients who underwent EVLT had a higher recurrence rate during the two-year follow-up period than those who underwent conventional surgery (33.33% vs 21.46%, χ2 = 11.506, P = 0.001), and a greater percentage of patients who underwent EVLT experienced pain one week after the procedure (39.85% vs 19.54%, P = 0.000).
EVLT may not always be the best option for the treatment of great saphenous vein varicosis.
Core Tip: In the study, we first time use a propensity score matching analysis to compare endovenous laser treatment (EVLT) and conventional surgery for great saphenous vein varicosis, we found that EVLT offers advantages in terms of surgical time and invasiveness. However, it exhibits a higher postoperative recurrence rate and greater postoperative pain compared to conventional surgery. Propensity score matching was employed to reduce bias. These findings emphasize the importance of considering individual patient characteristics and preferences when selecting the optimal treatment method for varicose veins, shedding light on the nuanced trade-offs between EVLT and conventional surgery in clinical practice.