The lower limbs are the most typical sites of varicose veins, which are superficial veins that are enlarged, stretched out, and twisted due to persistent venous insufficiency. They are among the most common vascular diseases in the world, impacting 20-30% of adults. The risk is higher for women, the elderly, patients who are overweight, and people whose jobs require them to stand for long periods of time [1, 2]. While varicose veins may not seem like a big deal, they can really cause a lot of pain, exhaustion, swelling, cramps in the nite, itching, darkening of the skin, lipodermatosclerosis, and venous ulceration—all of which can have a negative impact on one's quality of life [3].

Incompetence of the venous valves and hypertension of the veins are the main contributors to the pathophysiology of varicose veins. Progressive venous enlargement and alterations in vein wall structure occur as a consequence of retrograde blood flow and venous reflux caused by malfunctioning venous valves. Although perforator vein incompetence and involvement of the small saphenous vein are less prevalent, the great saphenous vein is the most frequently afflicted. Inflammatory alterations, microcirculatory dysfunction, and tissue damage are subsequent effects of chronic venous hypertension, which in turn contribute to the advancement of chronic venous illness [4, 5].

Duplex Doppler ultrasonography is still the most reliable tool for evaluating venous architecture, reflux patterns, and venous obstruction; it is used in conjunction with clinical examination to confirm the presence of varicose veins. When assessing the seriousness of a condition and the efficacy of a treatment, many turn to the Venous Clinical Severity Score (VCSS) and the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) categorisation [6].

The gold standard for treating symptomatic varicose veins for a long time was traditional surgery, which included high ligation of the saphenofemoral junction and stripping of the great saphenous vein. In order to permanently alleviate symptoms of venous reflux, surgical treatment is the way to go. On the other hand, traditional surgery involves cuts, local or general anaesthesia, and a long list of side effects including pain, bruising, nerve damage, haematomas, and wound problems. Less intrusive treatment approaches have been developed in response to these constraints [7, 8].

A minimally invasive technique for treating varicose veins, Endovenous Laser Ablation (EVLA) has become increasingly popular in the last 20 years. The endothelial damage, vein wall fibrosis, and vein closure that result from the heat energy delivered during EVLA are brought about by the ultrasonic guidance of the laser fiber's insertion into the incompetent vein. No substantial surgical dissection is required for the technique, which is usually carried out under local tumescent anaesthesia and permits therapy through a percutaneous approach [9].

Since conventional surgery and endovenous laser ablation (EVLA) are two options for treating primary varicose veins in the lower limbs, this study aimed to compare the two. The purpose of this study was to compare the two treatment methods for procedural outcomes, postoperative discomfort, recovery characteristics, clinical improvement, and complication rates.

This prospective comparative study was conducted in the Department of General Surgery, Mahavir institute of Medical sciences, vikarabad between April 2025 to march 2026. A total of 30 patients diagnosed with primary lower-limb varicose veins were enrolled in the study after obtaining written informed consent. Ethical clearance was obtained from the Institutional Ethics Committee prior to commencement of the study. All patients underwent detailed clinical evaluation, including history taking, physical examination, CEAP (Clinical-Etiological-Anatomical-Pathophysiological) classification, and duplex Doppler ultrasonography for confirmation of venous reflux and assessment of venous anatomy. Methods: Preoperative assessment included routine hematological investigations, coagulation profile, electrocardiography, and duplex Doppler ultrasound evaluation of the superficial and deep venous systems. Endovenous Laser Ablation (EVLA): In the EVLA group, the incompetent saphenous vein was cannulated under ultrasound guidance. A laser fiber was advanced to a point approximately 1–2 cm distal to the saphenofemoral junction. Tumescent anesthesia was administered around the vein, and laser energy was delivered during gradual withdrawal of the fiber to achieve thermal ablation and closure of the incompetent vein. Compression bandaging and compression stockings were applied after the procedure. Conventional Surgery: Patients in the conventional surgery group underwent high ligation of the saphenofemoral junction with stripping of the great saphenous vein under spinal or general anesthesia. Multiple phlebectomies were performed where necessary. Standard postoperative wound care and compression therapy were provided. Follow-Up: Patients were followed up at 1 week, 1 month, 3 months, and 6 months after intervention. Clinical improvement was assessed using the Venous Clinical Severity Score (VCSS), while duplex Doppler ultrasonography was used to evaluate vein occlusion and recurrence. Postoperative pain, duration of hospital stay, return to normal activity, and complications were recorded. Inclusion Criteria: 1. Patients aged 18–70 years. 2. Clinically diagnosed primary varicose veins of the lower limb. 3. Duplex Doppler-confirmed saphenous vein incompetence. 4. CEAP clinical class C2–C5. 5. Symptomatic patients presenting with pain, swelling, heaviness, skin changes. 6. Patients willing to participate and comply with follow-up visits. 7. Provision of written informed consent. Exclusion Criteria: 1. Recurrent varicose veins after previous intervention. 2. Deep vein thrombosis or post-thrombotic syndrome. 3. Peripheral arterial disease. 4. Pregnancy or lactation. 5. Active lower-limb infection or cellulitis. 6. Known coagulation disorders. 7. Severe cardiac, hepatic, or renal disease rendering surgery unsafe. 8. Patients unwilling to participate in the study. Statistical Analysis: Statistical Package for the Social Sciences (SPSS) version 26.0 was used for analysis after data was input into Microsoft Excel. Mean ± standard deviation (SD) was used to represent continuous variables, whereas frequencies and percentages were used for categorical variables. For continuous variables, we used the independent Student's t-test; for categorical variables, we used the Chi-square test or Fisher's exact test. We compared the EVLA and standard surgery groups. To evaluate the two treatment approaches' effectiveness, postoperative recovery, and complication rates, the results were presented in tabular form.

A total of 30 patients with primary lower-limb varicose veins were included in the study. Fifteen patients underwent Endovenous Laser Ablation (EVLA) and fifteen underwent Conventional Surgery (high ligation with vein stripping). All patients completed the six-month follow-up period and were included in the final analysis.

Table 1. Baseline Demographic and Clinical Characteristics of Study Participants

Table 1 shows the baseline demographic and clinical characteristics of the study population. Both treatment groups were comparable with respect to age, gender distribution, duration of symptoms, and disease severity, with no statistically significant differences observed.

Table 2. Operative and Recovery Characteristics

Table 2 demonstrates that patients treated with EVLA experienced significantly shorter procedure duration, reduced hospital stay, and earlier return to normal daily activities compared to those undergoing conventional surgery.

Table 3. Comparison of Postoperative Pain Scores

Table 3 shows postoperative pain assessment using the Visual Analog Scale (VAS). Patients treated with EVLA reported significantly lower pain scores at all follow-up intervals compared to those undergoing conventional surgery.

Table 4. Clinical Improvement and Treatment Success at Six Months

Table 4 illustrates the clinical outcomes at six months. Both groups demonstrated significant improvement in VCSS. Complete vein occlusion rates were slightly higher in the EVLA group, although the difference was not statistically significant.

Table 5. Postoperative Complications

Table 5 summarizes postoperative complications observed in both groups. The overall complication rate was lower in the EVLA group (13.3%) compared with the conventional surgery group (40.0%). Bruising was the most common complication, while wound infections and hematomas were observed only in patients undergoing conventional surgery.

Common symptoms of chronic venous illness include varicose veins, which cause pain, swelling, cosmetic issues, and lower quality of life. Microinvasive endovenous techniques have revolutionised venous insufficiency treatment, offering alternatives to surgery [10]. Endovenous Laser Ablation (EVLA) and Conventional Surgery for main lower-limb varicose veins were evaluated for clinical results, recuperation, and complications. Both treatments were effective, but EVLA improved postoperative recovery, discomfort, and patient satisfaction [11]. In this study, the two therapy groups had similar demographics. Male patients dominated the study, with a mean age of 45. Varicose veins afflict middle-aged adults and people in standing-heavy jobs, according to prior studies. The comparable baseline features between groups allowed treatment method to explain outcomes rather than confounding factors [12, 13]. In the previous study Myers KA, 2008 found that EVLA patients had shorter operation times and hospital stays. EVLA's minimally invasive nature permits percutaneous treatment under local tumescent anaesthesia, decreasing surgical trauma and enabling early ambulation. However, conventional surgery requires wider incisions, vein stripping, and more tissue dissection, which increases operative time and hospitalisation. These findings support earlier randomised trials showing quicker recovery and shorter hospital stays after EVLA [14]. In this study venous Clinical Severity Scores (VCSS) improved significantly in both therapy groups at six months, demonstrating venous symptom alleviation and clinical status improvement. The groups improved similarly, demonstrating that EVLA and conventional surgery reduce venous reflux and enhance venous haemodynamics. Duplex ultrasonography showed total venous occlusion in approximately 85% of patients in both groups. These findings confirm that both treatment methods achieve persistent venous closure [15-17]. In the previous study Merchant RF, Pichot O, 2005 reported the six-month follow-up recurrence rate was low in both groups, albeit slightly lower in the EVLA group. The difference was not statistically significant, although ultrasound-guided thermal energy delivery during EVLA may target refluxing venous segments. The necessity of cautious patient selection and comprehensive venous reflux treatment is highlighted by long-term follow-up studies showing comparable recurrence rates between EVLA and traditional surgery [18]. EVLA patients had less postoperative problems than conventional patients. Due to tissue stress and surgical incision difficulties, traditional surgery caused higher bruising, haematomas, and wound infections. One of the biggest clinical benefits of EVLA is its decreased complication rate. Minor problems include temporary paraesthesia and localised bruises after EVLA are usually self-limiting and rarely require treatment [19, 20]. In the previous study Kumar et al., 2024, treated with EVLA were happier. Reduced discomfort, scarring, hospitalisation, and return to normal activities may have led to improved satisfaction scores in this group. Modern healthcare emphasises patient-centered results, highlighting the benefits of minimally invasive treatment methods that improve clinical outcomes and patient experience [21]. This study supports the growing amount of data that EVLA is a safe and effective alternative to surgery for primary varicose veins. Both methods have good clinical outcomes, but EVLA has fewer postoperative complications, shorter hospital stays, faster recovery, and higher patient satisfaction, making it a good choice for appropriately selected chronic venous insufficiency patients [22, 23].

There was a marked improvement in clinical outcomes and a high rate of vein occlusion following treatment of primary varicose veins using either conventional surgery or endovenous laser ablation (EVLA). But EVLA showed obvious benefits, such as less postoperative pain, less time in the hospital, quicker recovery, fewer problems, and more patient satisfaction. Although the two procedures were equally effective, EVLA is the better choice for certain individuals because to its shorter recovery time and less intrusive nature. Evaluating long-term results and recurrence rates requires additional research with bigger samples and longer follow-up periods.

Funding:

Not applicable.

Conflict of interest:

The authors declare that they have no conflict of interest.