A recent article in Scientific Reports examined the effectiveness of a combined one-stop endovenous laser ablation (EVLA) and stent angioplasty (SA) procedure versus two-staged approaches for managing varicose veins (VVs) and iliac vein compression syndrome (IVCS). The study assessed clinical outcomes, complications, and quality-of-life (QoL) improvements for patients undergoing these treatments.
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The Role of EVLA in Vascular Surgery
EVLA has become a key technique in vascular surgery, offering a minimally invasive alternative to traditional procedures for treating VVs. Using laser energy to thermally close abnormal veins, EVLA helps resolve symptoms associated with venous insufficiency. This approach provides notable benefits, including shorter recovery times, fewer complications, and higher patient satisfaction than conventional surgical methods.
IVCS, also referred to as May-Thurner syndrome, arises when the right common iliac artery compresses the left common iliac vein, leading to venous hypertension. This condition can cause VVs and related complications such as pain, swelling, and discomfort. Combining EVLA with stent angioplasty (or balloon angioplasty, BA) not only targets the compression but also resolves the venous insufficiency, making it a comprehensive treatment approach.
Study Design and Patient Groups
The study evaluated 424 patients treated for VVs and IVCS between June 2017 and June 2020 at two hospitals in China. Participants were divided into four groups based on the type and timing of their procedures:
- One-stop SA with EVLA (91 patients)
- Two-staged SA with EVLA (132 patients)
- One-stop BA with EVLA (104 patients)
- Two-staged BA with EVLA (97 patients)
All patients were diagnosed through ultrasonography and digital subtraction angiography, and procedures were performed under local anesthesia. One-stop interventions involved performing EVLA within 48 hours of the initial procedure, while two-staged treatments required a 30-day interval.
The researchers assessed clinical outcomes using the CEAP classification system, while QoL was evaluated using the venous clinical severity score (VCSS) and Villalta scale. Follow-ups occurred at three and twelve months post-treatment, with ethical compliance ensured through institutional review board approval and patient consent.
Key Findings and Their Significance
The results showed that the one-stop SA procedure significantly improved clinical outcomes compared to the two-staged approaches.
The incidence of iliac vein stenosis was much lower in the one-stop group (p < 0.001). Recurrence rates for VVs were reduced in the one-stop and two-staged SA groups, with only 3 and 5 cases reported, respectively, compared to higher rates in the one-stop and two-staged BA groups (14 and 11 cases, respectively; p < 0.01). This indicates the potential of stenting to offer long-lasting solutions for patients.
The study also found higher re-intervention rates in the BA groups, suggesting that stenting may provide better long-term results. QoL assessments indicated significant improvements in the one-stop group, highlighting the efficacy of this approach in enhancing overall QoL. In contrast, the BA groups showed higher recurrence rates and a need for re-interventions.
Additionally, demographic analysis demonstrated that patients in the stent angioplasty groups were generally older and had higher body mass index (BMI) values, which could influence outcomes. Despite these differences, the greatest improvement in QoL was observed in the one-stop group, as measured by the VCSS and Villalta scale.
Statistical analyses confirmed a positive correlation between improved VCSS scores and the use of one-stop procedures, further supporting the idea that concurrent stent placement and EVLA offer better relief from venous hypertension and its symptoms.
Clinical Implications
The findings emphasize the value of one-stop EVLA combined with stent angioplasty as a first-line treatment for patients with VVs and IVCS. By demonstrating superior clinical outcomes, lower recurrence rates, and better QoL improvements, this approach offers significant benefits for patients and healthcare providers.
The study also highlights the importance of individualized treatment strategies. For younger patients or those with specific risk factors, a two-staged BA approach might provide better outcomes by allowing for close monitoring and management of complications. Personalizing treatment plans ensures optimized care and resource allocation.
Conclusion and Future Directions
This research provides compelling evidence that one-stop EVLA with stent angioplasty is an effective and efficient treatment for managing VVs and IVCS. The approach not only improves clinical outcomes but also enhances QoL for patients, making it a promising option in vascular surgery.
Future studies should build on these findings by conducting larger randomized controlled trials to confirm long-term efficacy. Comparative research on other interventions, such as radiofrequency ablation, could further refine treatment strategies. A deeper understanding of the mechanisms behind these results may also lead to improved protocols and enhanced patient care in vascular treatments.
Journal Reference
Chen, H., et al. (2025). One-stop endovenous laser ablation leads to superior outcomes for varicose veins and iliac vein compression. Sci Rep. DOI: 10.1038/s41598-025-85306-6, https://www.nature.com/articles/s41598-025-85306-6
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