title: A systematic review and meta-analysis of the treatments of varicose veins.
abstract: OBJECTIVE
  Several treatment options exist for varicose veins. In this review we summarize the available evidence derived from comparative studies about the relative safety and efficacy of these treatments.
  
  
  METHODS
  We searched MEDLINE, Embase, Current Contents, Cochrane Central Register of Controlled Trials (CENTRAL) expert files, and the reference section of included articles. Eligible studies compared two or more of the available treatments (surgery, liquid or foam sclerotherapy, laser, radiofrequency ablations, or conservative therapy with compression stockings). Two independent reviewers determined study eligibility and extracted descriptive, methodologic, and outcome data. We used random-effects meta-analysis to pool relative risks (RR) and 95% confidence intervals (CI) across studies.
  
  
  RESULTS
  We found 39 eligible studies (30 were randomized trials) enrolling 8285 participants. Surgery was associated with a nonsignificant reduction in the risk of varicose vein recurrence compared with liquid sclerotherapy (RR, 0.56; 95% CI, 0.29-1.06) and all endoluminal interventions (RR, 0.63; 95% CI, 0.37-1.07). Studies of laser and radiofrequency ablation and foam sclerotherapy demonstrated short-term effectiveness and safety. The quality of evidence presented in this review was limited by imprecision (small number of events), short-term follow-up, and indirectness (use of surrogate outcomes).
  
  
  CONCLUSIONS
  Low-quality evidence supports long-term safety and efficacy of surgery for the treatment of varicose veins. Short-term studies support the efficacy of less invasive treatments, which are associated with less periprocedural disability and pain.
authors.affiliation: Knowledge and Evaluation Research Unit, Division of Preventive Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. murad.mohammad@mayo.edu
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
authors.forename: Fernando
authors.initials: F
authors.lastname: Coto-Yglesias
authors.forename: Magaly
authors.initials: M
authors.lastname: Zumaeta-Garcia
authors.forename: Mohamed B
authors.initials: MB
authors.lastname: Elamin
authors.forename: Murali K
authors.initials: MK
authors.lastname: Duggirala
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.forename: Peter
authors.initials: P
authors.lastname: Gloviczki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058128:Compression Bandages / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D015911:Sclerotherapy / Q000009:adverse effects; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014648:Varicose Veins / Q000175:diagnosis / Q000628:therapy*; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D055815:Young Adult