What’s the Best Way to Get Rid of Varicose Veins? Surgery, Laser, or Sclerotherapy
Varicose veins (VV) may cause both symptomatic and cosmetic burdens upon patients. Several therapeutic interventions are available, each of which usually provides a very favorable outcome, but there are little data to compare treatments. Foam sclerotherapy (FSCL) is the newest addition to treatment choices. The process of FSCL is similar to prior techniques that instill sclerosant agents into the target vessels, except that by agitation of the sclerosant and mixing with air, a smaller volume of sclerosant is necessary to induce vascular inflammation and scarring. Laser ablation of the truncal saphenous vein is performed under local anesthesia. Surgery involved ligation and stripping of the great saphenous vein proximally with concurrent phlebectomies.
Brittenden et al performed a direct comparative trial between these three methods of intervention. At 6 months, results among the randomized patients (n = 798) were quite similar. Quality-of-life scores post-intervention were statistically slightly better for laser or surgery than FSCL, but of minimal clinical significance. The laser group had the lowest rates of complications (1%), but even in the surgical and FSCL groups, adverse effects happened in < 10% of cases, and none were serious.
All treatments were well tolerated and produced good outcomes, with minor differences favoring either laser treatment or surgery over FSCL. Based upon these data, operator preference and experience should likely be an important determinant in choice of treatment.
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