The quality of evidence is downgraded by study limitations (lack of blinding).
A Cochrane review included 13 studies with a total of 3 081 subjects. Three studies compared ultrasound-guided foam sclerotherapy (UGFS) with surgery, 8 compared endovenous laser therapy (EVLT) with surgery and 5 compared radiofrequency ablation (RFA) with surgery. Only one study had long-term (5-year) data.
Ultrasound-guided foam sclerotherapy (UGFS) versus surgery: There was no difference in the rate of recurrences measured by clinicians (OR 1.74, 95% CI 0.97 to 3.12; 3 studies, n=766) or of symptomatic recurrence (OR 1.28, 95% CI 0.66 to 2.49; 1 study, n=390) between UGFS and surgery. Recanalisation and neovascularisation were only evaluated in a single study. Recanalisation at < 4 months had an OR of 0.66 (95% CI 0.20 to 2.12), recanalisation > 4 months an OR of 5.05 (95% CI 1.67 to 15.28) and for neovascularisation an OR of 0.05 (95% CI 0.00 to 0.94). There was no difference in the rate of technical failure between the two groups (OR 0.44, 95% CI 0.12 to 1.57; 2 studies, n=429).
Endovenous laser therapy (EVLT) versus surgery: There were no differences between the treatment groups for either clinician noted (OR 0.72, 95% CI 0.43 to 1.22; 7 studies, n=1 450) or symptomatic recurrence (OR 0.87, 95% CI 0.47 to 1.62; 3 studies, n=522). Both early (OR 1.05, 95% CI 0.09 to 12.77; 3 studies, n=519) and late recanalisation (OR 4.14, 95% CI 0.76 to 22.65; 4 studies, n=743) were no different between the two treatment groups. Neovascularisation (OR 0.05, 95% CI 0.01 to 0.22; 4 studies, n=760) and technical failure (OR 0.29, 95% CI 0.14 to 0.60; 6 studies, n=1 255) were both statistically reduced in the laser treatment group. Long-term (5-year) outcomes were evaluated in one study so no association could be derived, but it appeared that EVLT and surgery maintained similar findings.
Radiofrequency ablation (RFA) versus surgery: There were no differences in clinician noted recurrence (OR 0.82, 95% CI 0.49 to 1.39; 4 studies, n=487); symptomatic noted recurrence was only evaluated in a single study. There were also no differences between the treatment groups for recanalisation (early OR 0.68, 95% CI 0.01 to 81.18; 4 studies, n=469 or late OR 1.09, 95% CI 0.39 to 3.04; 3 studies, n=325), neovascularisation (OR 0.31, 95% CI 0.06 to 1.65; 2 studies, n=93) or technical failure (OR 0.82, 95% CI 0.07 to 10.10; 5 studies, n=645).
QoL scores, operative complications and pain were not amenable to meta-analysis, however quality of life generally increased similarly in all treatment groups and complications were generally low, especially major complications. Pain reporting varied greatly between the studies but in general pain was similar between the treatment groups.
An RCT included a total of 224 legs with great saphenous varicose veins (GSV), of which 69 were randomized to conventional surgery, 78 to endovenous laser ablation (EVLA), and 77 to ultrasound-guided foam sclerotherapy (UGFS). At 5 years, Kaplan-Meier estimates of obliteration or absence of the GSV were 85% (95% CI 75 to 92) in the conventional surgery, 77% (95% CI 66 to 86) in EVLA, and 23% (95% CI 14 to 33) in UGFS groups. Absence of above-knee GSV reflux was found in 85% (73 to 92), 82% (72 to 90) and 41% (30 to 53) respectively. Chronic venous dIsease quality of life questionnaire (CIVIQ) scores deteriorated over time in patients in the UGFS group, and were significantly worse than those in the EVLA group (P = 0.013). CIVIQ scores for the conventional surgery group did not differ from those in the EVLA and UGFS groups.
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