title: A systematic review and meta-analysis on the role of varicosity treatment in the context of truncal vein ablation.
abstract: BACKGROUND
  With the advent of endovenous truncal ablation under local anaesthetic for the treatment of varicose veins, the fate of varicosed tributaries has become controversial, with centres offering different timings of treatment, if offered at all. This study aims to review the literature assessing delayed and simultaneous varicosity treatment during truncal ablation.
  
  
  METHODS
  Randomised trials and cohort studies concerning varicosity treatment timing were identified through a systematic literature search. Requirements for further treatment, quality of life and rate of venous thrombotic events were assessed for meta-analysis.
  
  
  RESULTS
  Four studies were identified assessing need for further varicosity procedure, with no significant difference seen between simultaneous or delayed treatment (p = 0.339). Two studies assessed quality of life, with simultaneous treatment providing significantly improved outcomes at six weeks (p = 0.029) but not at 12 weeks (p = 0.283). Studies examining venous thrombotic events showed no difference in venous thromboembolism rate between simultaneous or delayed treatment approaches (p = 0.078).
  
  
  CONCLUSIONS
  The evidence base regarding timing of varicosity treatment is sparse; however, it does show that simultaneous treatment of varicosities leads to early gains in quality of life, with a non-significant trend for fewer further procedures but more venous thrombotic events.
authors.affiliation: Academic Section of Vascular Surgery, Imperial College London, London, UK Tristan.lane@imperial.ac.uk.
authors.forename: T R A
authors.initials: TR
authors.lastname: Lane
authors.affiliation: Academic Section of Vascular Surgery, Imperial College London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Onida
authors.affiliation: Academic Section of Vascular Surgery, Imperial College London, London, UK Department of Vascular Surgery, Cambridge Universities NHS Foundation Trust, Cambridge, UK.
authors.forename: M S
authors.initials: MS
authors.lastname: Gohel
authors.affiliation: Academic Section of Vascular Surgery, Imperial College London, London, UK London Vascular Clinic, London, UK.
authors.forename: I J
authors.initials: IJ
authors.lastname: Franklin
authors.affiliation: Academic Section of Vascular Surgery, Imperial College London, London, UK.
authors.forename: A H
authors.initials: AH
authors.lastname: Davies
mesh_terms: D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D014648:Varicose Veins / Q000628:therapy*; D054556:Venous Thromboembolism / Q000209:etiology*; D020246:Venous Thrombosis / Q000209:etiology*
keywords: Varicose veins; avulsion; endovenous; phlebectomy; truncal ablation; varicosity