Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for varicose veins Varicose veins are dilated, tortuous superficial veins. When they are in the legs they can be painful, particularly when standing and walking, itchy and unsightly. Varicose veins are conventionally treated with surgery to remove the veins, by stripping them to the level of the knee (so-called high ligation and stripping). New less invasive treatments seal the main leaking vein in the thigh using laser (endovenous laser therapy), radiofrequency ablation (RFA) or foam sclerotherapy. These techniques may result in less pain after the procedure, fewer complications and a quicker return to work and normal activities with improved patient quality of life, as well as avoiding the need for a general anaesthetic. Our review brought together all available randomised controlled trials that compared the new techniques to surgery in the treatment of varicosities in the great saphenous vein. We found only five trials, with a combined total of 450 patients, which met our inclusion criteria. Three trials compared laser therapy with surgery and two trials compared RFA with surgery. Laser therapy was associated with less technical failure but a trend to higher rates of reopening of the treated vein (recanalisation) compared with surgery. No results were available to compare the rates of recurrence. We found that RFA was associated with trends for fewer technical failures and less new vein growth (neovascularisation) compared with surgery; the trend was for more recanalisation within four months with no demonstrated difference in recurrence of varicose veins. No randomised controlled trial compared sclerotherapy with surgery. The results in the study reports were presented as either the number of legs or number of patients, where some patients had varicose veins in both legs. The outcomes were also measured at different times after the procedures for the different trials. This limited the findings of our review. We can conclude from the limited available evidence that RFA and EVLT are no worse than HL/S. Our review is not powered to make any robust recommendations that affect clinical practice. We need more RCT data comparing these novel therapies to HL/S before we really know their true potential.
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