title: A comparison of the effectiveness of treating those with and without the complications of superficial venous insufficiency.
abstract: OBJECTIVE
  To test the hypothesis that patients with soft tissue changes related to superficial venous insufficiency (SVI) have greater benefits from treatment than those with only symptomatic varicose veins.
  
  
  BACKGROUND
  A commonly held view is that SVI is only a minor ailment, yet randomized clinical trials (RCTs) show that treatment improves quality of life (QoL) and is cost-effective. In an effort to curb the treatment costs of this common disorder, rationing is applied in many health care systems, often limiting the reimbursement of treatment to those with soft tissue changes.
  
  
  METHODS
  This cohort study draws its data from an interventional RCT. After informed consent, consecutive patients with symptomatic unilateral SVI were randomized to receive surgical ligation and stripping or endovenous laser ablation. This analysis differentially studies the outcomes of patients with simple varicose veins (C2: n = 191) and soft tissue complications (C3-4: n = 76). Effectiveness outcomes measured up to 1 year included the following: Qol [short form 36 (SF36), EuroQol, and the Aberdeen Varicose Veins Questionnaire], clinical recurrence, and the need for secondary procedures. Multivariable regression analysis was used to control for potential confounding factors.
  
  
  RESULTS
  Both groups saw significant improvements in QoL. All improvements were equal between groups apart from the SF36 domain of Bodily Pain, where C2 saw an improvement of 12.8 [95% confidence interval (CI): 4.8-20.8] points over C3-4 participants (P = 0.002), who also suffered more recurrence [odds ratio (OR) = 2.7, 95% CI: 1.2-6.1, P = 0.022] and required more secondary procedures (OR = 4.4, 95% CI: 1.2-16.3, P = 0.028).
  
  
  CONCLUSIONS
  This study suggests that rationing by clinical severity contradicts the evidence. Delaying treatment until the development of skin damage leads to a degree of irreversible morbidity and greater recurrence.
  
  
  BACKGROUND
  NCT00759434 Clinicaltrials.gov.
authors.affiliation: From the Academic Vascular Surgical Unit, Hull York Medical School, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Carradice
authors.forename: Tom
authors.initials: T
authors.lastname: Wallace
authors.forename: Risha
authors.initials: R
authors.lastname: Gohil
authors.forename: Ian
authors.initials: I
authors.lastname: Chetter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014689:Venous Insufficiency / Q000601:surgery*