A review of current treatment strategies for varicose veins.

Badri H, Bhattacharya V.

Senior Fellow in Vascular Surgery, Queen Elizabeth Hospital, Gateshead, NE9 6SX, Consultant General and Vascular Surgeon, Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK. vbhatta@yahoo.com.

Objectives: To systematically review data to determine if Endovenous Laser Ablation (EVLA), Radio Frequency Ablation (RFA), and Foam Sclerotherapy (FS) have any advantages or disadvantages in comparison with conventional surgical ligation and stripping of great saphenous vein (GSV) varices.

EVLA versus Surgery: The failure rate of GSV closure after EVLA was between 0% to 34%. In comparison the recurrence rate after high ligation and stripping was up to 28% in a meta analysis of 7 studies. The overall complication rate after EVLA is about 20%. This showed no difference from that after primary LSV surgery which is between 17% and 20%.

RFA versus Surgery: There was no significant difference between RFA and surgery in terms of symptoms improvement. However, the pain score was better in the RFA groups. Moreover, there was significant difference in the sick leave taken after each treatment with the mean of 6.5 days and 4.7 days for RFA, and 15.6 days and 12.4 days for surgery.

RFA versus EVLT: Immediate technical success was obtained in all (100%) of EVLA procedures and in (96%) of RFA cases. The overall complication rate was (20.8%) after EVLA and 7.6% after RFA.

Foam Sclerotherapy: The recurrence rate after Sclerotherapy reached 30.5 % after one year, and 51% after 10 years. However, the rates were better for Foam than the liquid sclerosants. When compared to surgery, sclerotherapy had higher recurrence rate than that after surgery. The median time to return to normal activities was significantly reduced in the foam sclerotherapy group (2 days) compared to the surgical group (8 days).

Current & Future Development: When comparing the recurrence rate and overall complication rate and symptoms relief, surgery was not inferior to endovenous procedures. Reported follow up periods for the endovenous procedures were relatively short.

Recent Patents Cardiovasc Drug Discov. 2008 Jun;3(2):126-36.