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Randomized Controlled Trial
. 2016 Oct;103(11):1438-44.
doi: 10.1002/bjs.10260. Epub 2016 Aug 26.

Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins

M Venermo  1 , J Saarinen  2 , E Eskelinen  3 , S Vähäaho  3 , E Saarinen  3 , M Railo  3 , I Uurto  2 , J Salenius  2 , A Albäck  3 ; Finnish Venous Study Collaborators
Collaborators, Affiliations
Randomized Controlled Trial

Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins

M Venermo et al. Br J Surg. 2016 Oct.

Abstract

Background: Endovenous ablation techniques and ultrasound-guided foam sclerotherapy (UGFS) have largely replaced open surgery for treatment of great saphenous varicose veins. This was a randomized trial to compare the effect of surgery, endovenous laser ablation (EVLA) (with phlebectomies) and UGFS on quality of life and the occlusion rate of the great saphenous vein (GSV) 12 months after surgery.

Methods: Patients with symptomatic, uncomplicated varicose veins (CEAP class C2-C4) were examined at baseline, 1 month and 1 year. Before discharge and at 1 week, patients reported a pain score on a visual analogue scale. Preoperative and 1-year assessments included duplex ultrasound imaging and the Aberdeen Varicose Vein Severity Score (AVVSS).

Results: The study included 214 patients: 65 had surgery, 73 had EVLA and 76 had UGFS. At 1 year, the GSV was occluded or absent in 59 (97 per cent) of 61 patients after surgery, 71 (97 per cent) of 73 after EVLA and 37 (51 per cent) of 72 after UGFS (P < 0·001). The AVVSS improved significantly in comparison with preoperative values in all groups, with no significant differences between them. Perioperative pain was significantly reduced and sick leave shorter after UGFS (mean 1 day) than after EVLA (8 days) and surgery (12 days).

Conclusion: In comparison with open surgery and EVLA, UGFS resulted in equivalent improvement in quality of life but significantly higher residual GSV reflux at 12-month follow-up.

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Figures

Figure 1
Figure 1
CONSORT diagram for the trial. EVLA, endovenous laser ablation; UGFS, ultrasound‐guided foam sclerotherapy
Figure 2
Figure 2
Patency of the great saphenous vein (GSV) at various diameters on duplex ultrasound imaging 1 year after a surgery, b endovenous laser ablation (EVLA) or c ultrasound‐guided foam sclerotherapy (UGFS)
Figure 3
Figure 3
Disease‐specific quality of life, measured by Aberdeen Varicose Vein Severity Score (AVVSS) at baseline and 1 year after surgery, endovenous laser ablation (EVLA) or ultrasound‐guided foam sclerotherapy (UGFS). Values are means with 95 per cent confidence intervals
Figure 4
Figure 4
Pain measured on a visual analogue scale (VAS; 1, none; 10, worst possible) a at the time of hospital discharge and b 1 week after surgery, endovenous laser ablation (EVLA) or ultrasound‐guided foam sclerotherapy (UGFS)
See this image and copyright information in PMC

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