VESPA Trial: Endovenous laser treatment versus crossectomy of the small saphenous vein.

Venous insufficiency has a high incidence worldwide. It is seen in 5-15% of all
men en 15-30% of all women in western countries, varying from cosmetic
complaints to chronic venous insuffiency and ulcers. The prevalence of
insufficiency of the small saphenous vein (SSV) is 10-18%. In the early
twentieth century the surgical procedure of choice for insufficiency of the
great saphenous vein (GSV) was the saphenofemoral ligation and GSV stripping.
Since stripping of the SSV resulted in a large number of nerve damages of the
sural nerve, the method was adjusted to the saphenopopliteal ligation. The
percentage of therapy failure (persistent insufficiency of the SSV
perioperatively) is 25%. Reflux at one year was seen in 52%. The number of
therapy failure is explained by the variable anatomy of the SSV and its
junction.
Endovenous laser treatment (EVLT) is a minimal invasive, percutaneous,
endovenous technique causing heat mediated steam bubbles resulting in
endothelial damage and occlusion of the venous segment. EVLT is a widely used
technique for treatment of insufficiency of the GSV. The use of EVLT for
treatment of the insufficient of the SSV has not been investigated earlier by a
randomized trial. Due to the fact that the SSV is cannulated under ultrasound
guidance, it is certain the correct vein is being treated. This may result in a
reduction of therapy failures and long term insufficiency.

This randomized trial will compare EVLT with saphenopopliteal ligation with
regard to therapy failure (a) and recurrence (b).


a. Insufficiency of the SSV determined by ultrasound 6 weeks post-treatment is
regarded as a therapy failure.
b. Determination of insufficiency of the SSV using ultrasound after one year.

randomized multi-center trial, non blinded

Ligation of saphenopopliteal junction versus EVLT.

The saphenopopliteal ligation is performed under spinal anaesthesia, the ELVT
is performed under local anaesthesia.