Systematic review of treatments for varicose veins

Abstract

This systematic review compares the safety and efficacy of varicose vein treatments, including conservative therapy, sclerotherapy, phlebectomy, endovenous laser therapy, radiofrequency ablation, and surgery involving saphenous ligation and stripping. Systematic searches of medical bibliographic databases were conducted in February 2008 to identify suitable studies published from January 1988 onward. Articles were considered eligible for inclusion through the application of a predetermined protocol. Safety and effectiveness data from the comparison of two or more varicose vein procedures were extracted and analyzed. Seventeen studies, published between 2003 and 2007, were included in this review. Serious adverse events were rare. Minor adverse events were more common but generally self-limiting. All treatments displayed levels of effectiveness depending on the extent of the vein in question. Short-term advantages appeared to be associated with sclerotherapy and endovenous treatments, and long-term effectiveness was more apparent following surgical intervention. Evidence suggests conservative therapy is less effective than sclerotherapy and surgery for the treatment of varicose veins. Ligation with stripping plus phlebectomy is generally regarded as the "gold standard" for treating primary long saphenous veins. Sclerotherapy and surgery both appear to have a place in the management of varicose veins. Sclerotherapy and phlebectomy may also be more appropriate in patients with minor superficial varicose veins not related to reflux of the saphenous system or as a post- or adjunctive treatment to other procedures, such as surgery. Current evidence suggests endovenous laser therapy and radiofrequency ablation are as safe and effective as surgery, particularly in the treatment of saphenous veins. Most importantly, the type of varicose vein should govern the intervention of choice, with no single treatment universally employed.