title: Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins.
abstract: BACKGROUND
  This randomized trial compared four treatments for varicose great saphenous veins (GSVs).
  
  
  METHODS
  Five hundred consecutive patients (580 legs) with GSV reflux were randomized to endovenous laser ablation (980 and 1470 nm, bare fibre), radiofrequency ablation, ultrasound-guided foam sclerotherapy or surgical stripping using tumescent local anaesthesia with light sedation. Miniphlebectomies were also performed. The patients were examined with duplex imaging before surgery, and after 3 days, 1 month and 1 year.
  
  
  RESULTS
  At 1 year, seven (5.8 per cent), six (4.8 per cent), 20 (16.3 per cent) and four (4.8 per cent) of the GSVs were patent and refluxing in the laser, radiofrequency, foam and stripping groups respectively (P < 0.001). One patient developed a pulmonary embolus after foam sclerotherapy and one a deep vein thrombosis after surgical stripping. No other major complications were recorded. The mean(s.d.) postintervention pain scores (scale 0-10) were 2.58(2.41), 1.21(1.72), 1.60(2.04) and 2.25(2.23) respectively (P < 0.001). The median (range) time to return to normal function was 2 (0-25), 1 (0-30), 1 (0-30) and 4 (0-30) days respectively (P < 0.001). The time off work, corrected for weekends, was 3.6 (0-46), 2.9 (0-14), 2.9 (0-33) and 4.3 (0-42) days respectively (P < 0.001). Disease-specific quality-of-life and Short Form 36 (SF-36(®)) scores had improved in all groups by 1-year follow-up. In the SF-36(®) domains bodily pain and physical functioning, the radiofrequency and foam groups performed better in the short term than the others.
  
  
  CONCLUSIONS
  All treatments were efficacious. The technical failure rate was highest after foam sclerotherapy, but both radiofrequency ablation and foam were associated with a faster recovery and less postoperative pain than endovenous laser ablation and stripping.
authors: Danish Vein Centres, Naestved, Denmark. lhr@varix.dk
authors: L H
authors: LH
authors: Rasmussen
authors: M
authors: M
authors: Lawaetz
authors: L
authors: L
authors: Bjoern
authors: B
authors: B
authors: Vennits
authors: A
authors: A
authors: Blemings
authors: B
authors: B
authors: Eklof
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D017115:Catheter Ablation / Q000191:economics / Q000379:methods*; D003365:Costs and Cost Analysis; D057510:Endovascular Procedures / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D012501:Saphenous Vein; D015911:Sclerotherapy / Q000191:economics / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014648:Varicose Veins / Q000191:economics / Q000628:therapy*; D055815:Young Adult