A recent article in Scientific Reports examined the effectiveness of a one-stage endovenous laser ablation (EVLA) plus stent angioplasty (SA) treatment compared with a two-stage approach in the management of varicose veins (VV) and iliac vein compression syndrome (IVCS). The study evaluated clinical outcomes, complications, and improvements in quality of life (QoL) in patients who underwent these treatments.
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The role of EVLA in vascular surgery
EVLA has become an important technique in vascular surgery, offering a less invasive alternative to traditional procedures in the treatment of VV. EVLA uses laser energy to thermally close abnormal veins, helping to relieve symptoms associated with venous insufficiency. This approach offers notable advantages over traditional surgical approaches, including faster recovery times, fewer complications, and increased patient satisfaction.
IVCS, also known as May-Tourner syndrome, occurs when the right common iliac artery compresses the left common iliac vein, causing venous hypertension. This condition can lead to VV and associated complications such as pain, swelling, and discomfort. Combining EVLA with stent angioplasty (or balloon angioplasty, BA) is a comprehensive treatment as it not only targets the compression but also addresses the underlying venous insufficiency.
Study design and patient population
This study evaluated 424 patients who underwent treatment for VV and IVCS at two hospitals in China from June 2017 to June 2020. Participants were divided into four groups based on procedure type and timing.
- One-stop SA with EVLA (91 patients)
- Two-stage SA with EVLA (132 patients)
- One-stop BA with EVLA (104 patients)
- Two-stage BA with EVLA (97 patients)
All patients were diagnosed by ultrasound and digital subtraction angiography, and procedures were performed under local anesthesia.In one-time interventions, EVLA is performed within 48 hours of the initial procedure, whereas in two-stage treatments, an interval of 30 days is required.
The researchers assessed clinical outcomes using the CEAP grading system and quality of life using the Venous Clinical Severity Score (VCSS) and the Villalta scale. Follow-up was performed at 3 and 12 months after treatment, and ethical compliance was ensured through Institutional Review Board approval and patient informed consent.
Key findings and their implications
Results showed that the one-stop SA procedure significantly improved clinical outcomes compared with the two-stage approach.
The iliac vein stenosis rate was significantly lower in the single-port group (p < 0.001). The 1-stage and 2-stage SA groups had a lower VV recurrence rate, with only 3 and 5 cases reported, respectively, whereas the 1-stage and 2-stage BA groups had a higher recurrence rate (14 and 11 cases, respectively, p < 0.01), demonstrating the potential of stents to provide a long-term solution for patients.
The study also found a higher reintervention rate in the BA group, suggesting that stent placement may improve long-term outcomes. QoL assessment showed significant improvement in the one-stop group, highlighting the effectiveness of this approach in improving overall QoL. In contrast, the BA group had a higher recurrence rate and required reintervention.
Furthermore, demographic analysis revealed that patients in the stent angioplasty group were generally older and had a higher body mass index (BMI), which may have influenced the results.Despite these differences, the greatest improvement in QoL was seen in the one-stop group, as measured by the VCSS and Villalta scores.
Statistical analysis confirmed a positive correlation between improvement in VCSS score and the use of one-stop surgery, further supporting the idea that simultaneous stent placement and EVLA can better alleviate venous hypertension and its symptoms.
Clinical significance
These results highlight the value of single-port EVLA in combination with stent angioplasty as a first-line treatment for patients with VV and IVCS. This approach offers significant benefits to patients and providers by demonstrating excellent clinical outcomes, lower recurrence rates, and improved QoL.
This study also highlights the importance of individualized treatment strategies. For younger patients and those with specific risk factors, a two-stage BA approach allows for close monitoring and management of complications and may result in better outcomes. Personalizing the treatment plan optimizes care and resource allocation.
Conclusions and future directions
This study provides compelling evidence that single-stage EVLA with angioplasty stents is an effective and highly efficient treatment for the management of VV and IVCS. This approach not only improves clinical outcomes but also improves patients’ quality of life, making it a promising option in vascular surgery.
Future studies should build on these findings with larger randomized controlled trials to confirm long-term efficacy. Comparative studies with other interventions, such as radiofrequency ablation, may further refine treatment strategies. A deeper understanding of the mechanisms behind these results may also lead to improved vascular treatment protocols and improved quality of patient care.
Reference magazines
Chen, H., et al. (2025). Single-pass endovenous laser ablation provides excellent results for varicose veins and pelvic vein compression. Scientific Reports DOI: 10.1038/s41598-025-85306-6, https://www.nature.com/articles/s41598-025-85306-6
