Abstract
OBJECTIVE: This study compares the surgical outcomes between endovenous laser ablation of the above-knee great saphenous vein (AK-GSV) and full-length great saphenous vein (FL-GSV) for the treatment of lower limb varicose veins. METHODS: This retrospective study analyzed clinical data from consecutive patients with lower extremity varicose veins treated at a tertiary vascular surgery center between November 2023 and December 2024. Participants were categorized into two groups based on surgical approach: the AK-GSV laser treatment group (n = 134) and the FL-GSV laser closure treatment group (n = 166). The study compared operative time, postoperative pain intensity, improvement in general symptoms, and incidence of saphenous nerve injury between the two groups. RESULTS: AK-GSV laser treatment was associated with shorter surgical duration (60.52 ± 8.26 minutes) compared with the FL- GSV laser treatment (64.01 ± 8.71 minutes; P = .000). Additionally, AK-GSV treatment was associated with milder early postoperative pain, as reflected by lower Visual Analogue Scale (VAS) scores at 1 day (2.82 ± 0.96 vs 3.14 ± 0.83; P = .002) and 3 days (1.57 ± 0.64 vs 1.77 ± 0.67; P =.01) postoperatively. The AK-GSV treatment group exhibited superior short-term outcomes, with significantly larger reductions in the Venous Clinical Severity Score (VCSS) (P = .009) and the Aberdeen Varicose Vein Questionnaire (AVVQ) score (P = .045) during the early postoperative period (within the first 1 month postoperatively) compared with the FL-GSV group. Compared with the FL-GSV treatment group, the AK-GSV group had a significantly lower incidence of saphenous nerve injury at 1 month (4.5% vs 15.7%; P = .002), 3 months (2.2% vs 8.4%; P = .021), and 9 months (0.0% vs 4.2%; P = .018). However, this intergroup difference was no longer statistically significant at 6 months (1.5% vs 5.4%; P = .072). CONCLUSIONS: AK-GSV endovenous laser ablation is a safe and effective minimally invasive treatment approach. Compared with FL-GSV ablation, this technique demonstrates comparable efficacy in improving venous stasis symptoms while offering significant advantages, including reduced operative time, decreased postoperative pain, accelerated recovery, and lower risks of neurological complications.