A Comparative Study to Compare Results of Treatment of Incompetent Perforators by Laser Versus Foam Sclerotherapy in Chronic Venous Insufficiency Patients

Abstract

Introduction: Patients of chronic venous insufficiency (CVI) of the leg can present with lower limb pain or heaviness, subcutaneous edema, skin changes such as hyperpigmentation with or without dermatitis and in advanced cases with ulcer in the gaiter area. Various modalities are now available for the treatment of CVI, namely endovenous thermal ablation, foam sclerotherapy, open surgical technique (stripping, phlebectomy, subfascial endoscopic perforator surgery and modified Linton procedure for the incompetent perforators.
Methods: In this study, adult patients of primary chronic venous insufficiency (C3-C6) diagnosed by venous duplex USG were enrolled. In both groups, the great saphenous vein (GSV) and short saphenous vein (SSV) were ablated by endovenous laser therapy. However, in group A, incompetent perforators were treated by endovenous laser ablation and in group B, they were treated with ultrasound-guided Foam sclerosant injection (0.5% Polidocanol). Patients were followed up for a period of 6 months.
Results: Technically all the incompetent perforators were feasible to puncture the perforators and to do the procedure. Anatomical closure rate of treated incompetent perforating veins In Group A at 1, 3 and 6 months was 68.33, 63.33 and 60.0%, respectively, while in Group B it was 65.95, 61.72 and 57.0%, respectively (statistically insignificant. Pain in group A at 1-month was mild (50%) and at 3 months only 10% and absent at 6 months, while in group B 50, 20% and absent at 6 months. Hyperpigmentation in group A was 06.66, 01.66 and absent at 1, 3, and 6 months, respectively, while in group B it was 10.63 and 04.25% and absent, respectively.
Conclusion: USG-guided endovenous laser ablation (EVLA) and Foam sclerotherapy are both technically feasible but the closure rate for treated perforators is almost the same for both techniques. In 6 month follow up, we found that EVLA is slightly better than foam sclerotherapy for the treatment of perforators but statistically insignificant.