Murad Alam, MD, MSCI

Surgical ligation and luminal laser ablation were both better than foam sclerotherapy.

To treat varicose veins, the greater saphenous vein may be tied off by surgical ligation, or thermal ablation of the greater saphenous vein may be delivered by endovenous laser, or ultrasound-guided sclerotherapy using injected sodium tetradecyl sulfate foam may be employed to injure the vessel wall. Using a series of measures of patient-reported disease-specific quality of life as the primary outcome measures, these authors conducted a randomized, multicenter trial in 798 patients. Secondary outcome measures were also numerous, including expert clinical assessment of residual disease.

At 6 weeks and at 6 months, disease-specific quality of life was moderately but significantly worse with foam sclerotherapy than with surgery (P=0.006); no differences in disease-specific quality of life were found between surgery and laser groups. The rate of complications, most minor, was markedly lower with laser (1.0%) than with foam (6.2%) or surgery (7.1%).

Citation(s):

Brittenden J et al. A randomized trial comparing treatments for varicose veins. N Engl J Med 2014 Sep 25; 371:1218.