Inflammatory and Hemostatic Biomarker Response After Endovenous Laser Ablation Versus High Ligation and Stripping: A Randomized Controlled Trial.

OBJECTIVE

This randomized controlled trial aimed to evaluate and compare perioperative inflammatory response, primary hemostasis, and coagulation cascade activation between endovenous laser ablation (EVLA) and high ligation and stripping (HLS) in patients with great saphenous vein (GSV) incompetence.

METHODS

This prospective randomized trial included 39 patients with unilateral GSV incompetence (CEAP C2-C6), randomized to EVLA using a 1470-nm radial fiber (n=21) or conventional HLS (n=18). Blood samples were collected at baseline, 8 hours, 7 days, and 30 days postoperatively to assess inflammatory cytokines, adhesion molecules, and acute-phase markers. The primary endpoint was differences in biomarker levels between techniques over time.

RESULTS

The EVLA group demonstrated significantly earlier return to daily activities compared to HLS (17 vs 30 days, p<0.0001). Distinct inflammatory patterns were observed: EVLA showed increased P-selectin at 1 week and elevated IL-1, TNF-α, and IL-6 at 1 month, indicating a delayed inflammatory response. In contrast, HLS demonstrated higher von Willebrand factor levels at 1 week, suggesting earlier endothelial activation. No cases of deep vein thrombosis or endovenous heat-induced thrombosis were observed.

CONCLUSIONS

EVLA and HLS exhibit distinct temporal patterns of inflammatory and hemostatic activation. EVLA is associated with a delayed pro-inflammatory response, whereas HLS demonstrates earlier endothelial activation. Despite these differences, both techniques showed similar safety profiles. These findings may contribute to individualized thrombotic risk stratification and perioperative management strategies in venous surgery.