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 (5ยท8 per cent), six (4ยท8 per cent), 20 (16ยท3 per cent) and four (4ยท8 per cent) of the GSVs were patent and refluxing in the laser, radiofrequency, foam and stripping groups respectively (P < 0ยท001). 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 0โ10) were 2ยท58(2ยท41), 1ยท21(1ยท72), 1ยท60(2ยท04) and 2ยท25(2ยท23) respectively (P < 0ยท001). The median (range) time to return to normal function was 2 (0โ25), 1 (0โ30), 1 (0โ30) and 4 (0โ30) days respectively (P < 0ยท001). The time off work, corrected for weekends, was 3ยท6 (0โ46), 2ยท9 (0โ14), 2ยท9 (0โ33) and 4ยท3 (0โ42) days respectively (P < 0ยท001). Disease-specific quality-of-life and Short Form 36 (SF-36ยฎ) scores had improved in all groups by 1-year follow-up. In the SF-36ยฎ domains bodily pain and physical functioning, the radiofrequency and foam groups performed better in the short term than the others.
Conclusion
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.