Varicose Veins: Laser, Foam, and Surgery Equally Effective

Lara C. Pullen, PhD

September 25, 2014

Varicose veins can be treated with foam, laser, or surgery. All treatments have a similar clinical efficacy (venous clinical severity score), and all are equally able to improve general patient quality of life at 6 months, according to a new study.

Julie Brittenden, MD, from the Division of Applied Medicine at the University of Aberdeen in the United Kingdom, and colleagues published the results of their randomized trial online September 25 in the New England Journal of Medicine. Theirs was a multicenter study that included 785 patients with primary varicose veins.

Patients were randomly assigned to receive foam sclerotherapy or laser treatment or surgery. The investigators did not evaluate radiofrequency ablation.

The primary outcome measures were disease-specific quality of life, as measured by the Aberdeen Varicose Vein Questionnaire, and general quality of life, as measured with the EuroQol Group 5-Dimension Self-Report Questionnaire and the Medical Outcomes Study 36-Item Short-Form Health Survey.

The baseline characteristics of the groups were similar, except the diameter of the great saphenous vein was larger in the laser group than the foam group, the incidence of reflux below the knee was greater in the foam group than the laser group, and the incidence of deep venous reflux was less in the surgery group than in the foam group. The team adjusted for these baseline scores and other covariates when making their analyses.

Although all treatments were clinically effective, the foam group had a slightly worse disease-specific quality of life than the surgery group (P = .006). In particular, patients in the foam group were less likely to experience successful ablation of the main trunks of the saphenous vein when compared with patients in the surgery group (P < .001). Disease-specific quality of life was similar for patients in the surgery and laser groups.

Complications (eg, lumpiness, skin staining, and numbness) were less frequent after laser treatment (P < .001). Procedural complications were 6% in the foam group, 7% in the surgery group, and 1% in the laser group. There was a 3% frequency of serious adverse events, a percentage that was similar in all groups.

The study was not blinded and did not include a sham procedure. Thus, none of the effects can be compared with a control. The results are, however, similar to those seen in smaller European randomized trials.

This research was supported by a grant from the Health Technology Assessment Programme of the National Institute for Health Research. The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Government Health Directorate. Dr. Brittenden reports receiving grants from Health Technology Assessment, UK. Seven coauthors have reported receiving support from the National Institute for Health Research. One coauthor reports receiving grant support from UK Health Technology Assessment. Five coauthors report receiving payment for the treatment of varicose veins. The other authors have disclosed no relevant financial relationships.

N Engl J Med. Published online September 25, 2014. Abstract

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