NEW YORK (PRWEB) November 15, 2006
There are a wealth of time- and trauma-saving venous disease treatments now available to patients, including endovenous laser ablation, radiofrequency ablation, and foam sclerotherapy. However, these cutting-edge advances suffer a significant disadvantage: because they are so new, they are not well studied, and may cause unpredictable long-term complications. Today at the 33rd annual VEITHsymposium™, Dr. Alun H. Davies of the Imperial College at Charing Cross Hospital (London, UK), will present their exploration of traditional open surgery vs. newer alternatives, suggesting that open surgery is still the superior ablation technique.
The benefits of traditional open surgery are impressive: it is a well-studied procedure, having been performed for over a century; it is easy to teach to new doctors; and it is less expensive than newer procedures; and it generally needs to be performed only once. General complications include deep vein thrombosis (0.15%), pulmonary embolus (0.06%), and wound complication, including infection (2.2%).
By contrast, alternative ablation treatments have only been in use for ten years, so there are few studies documenting long-term effects; they require more specialized training for new doctors; and the costly devices and training required keeps procedure costs high. Unlike open surgery, doctors cannot view the anatomy and must rely on ultrasound instead; as a result, follow-up sclerotherapy or phlebectomy is often required four to six weeks after the initial procedure. General complications for radiofrequency ablation include bruising, burns, paraesthesia, clinical phlebitis, and slightly higher rates of deep vein thrombosis (0.57%) and pulmonary embolus (0.17%) than occur after open surgery. Endovenous laser ablation is associated with similar complications, including bruising (24%--100%), burns (4.8%), paraesthesia (1%--36.5%), and induration along the length of the saphenous vein (55%--100%).
The limited medical literature available for newer procedures also makes comparing recurrence rates difficult. For traditional open surgery, recurrence rates have been tracked for as long as ten years, and range from 5%--60%. By contrast, the longest study of endovenous laser ablation available is only 39 months. Radiofrequency ablation is better documented; recent three-year study showed it had a significantly worse recurrence rate of 33% as compared to traditional open surgery, which showed a rate of only 23%.
These facts strongly suggest that newer endovascular procedures should be more thoroughly studied and compared with traditional open surgery, and that the best clinical practice is to empower patients with the information that they need to make a choice among them.
Davies said, "The jury remains out on the optimal way in which to treat patients presenting with primary venous incompetence; the endo-luminal techniques definitely have complications. The long-term recurrence rates have yet to be properly compared between the different modalities. It is likely that all the modalities will have their own niche market and hence the physician treating patients with varicose veins needs to be able to either be able to offer all the potential modalities or be prepared to refer patients on to a physician who could offer that patient the optimal mode of treatment."
Now entering its fourth decade, VEITHsymposium™ provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features 300 rapid-fire presentations from world-renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques.