title: Ambulatory varicosity avulsion later or synchronized (AVULS): a randomized clinical trial.
abstract: OBJECTIVE
  A randomized clinical trial assessing the difference in quality of life and clinical outcomes between delayed and simultaneous phlebectomies in the context of endovenous truncal vein ablation.
  
  
  BACKGROUND
  Endovenous ablation has replaced open surgery as the treatment of choice for truncal varicose veins. Timing of varicosity treatment is controversial with delayed and simultaneous pathways having studies advocating their benefits. A previous small randomized study has shown improved outcomes for simultaneous treatment.
  
  
  METHODS
  Patients undergoing local anesthetic endovenous thermal ablation were randomized to either simultaneous phlebectomy or delayed varicosity treatment. Patients were reviewed at 6 weeks, 6 months, and 1 year with clinical and quality of life scores completed, and were assessed at 6 weeks for need for further varicosity intervention, which was completed with either ultrasound-guided foam sclerotherapy or local anesthetic phlebectomy. Duplex ultrasound assessment of the treated trunk was completed at 6 months.
  
  
  RESULTS
  101 patients were successfully recruited and treated out of 221 suitable patients from a screened population of 393. Patients in the simultaneous group (n = 51) showed a significantly improved Venous Clinical Severity Score at all time points, 36% of the delayed group required further treatment compared with 2% of the simultaneous group (P < 0.001). There were no deep vein thromboses, with 1 superfificial venous thrombosis in each group.
  
  
  CONCLUSIONS
  Combined endovenous ablation and phlebectomy delivers improved clinical outcomes and a reduced need for further procedures, as well as early quality of life improvements.
authors.affiliation: *Academic Section of Vascular Surgery, Imperial College London †Vascular Department, Royal Oldham Hospital, Oldham, Lancashire; and ‡London Vascular Clinic, London, UK.
authors.forename: Tristan R A
authors.initials: TR
authors.lastname: Lane
authors.forename: Damian
authors.initials: D
authors.lastname: Kelleher
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Shepherd
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Franklin
authors.forename: Alun H
authors.initials: AH
authors.lastname: Davies
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D015911:Sclerotherapy / Q000379:methods; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014463:Ultrasonography; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000523:psychology* / Q000628:therapy*