Foam, laser, surgery compared as varicose vein treatments

A comparison of 3 treatments for varicose veins found small differences in effectiveness and safety among them.

The randomized trial included 798 patients with primary varicose veins who were treated at 11 centers in the U.K. with ultrasound-guided foam sclerotherapy, endovenous laser ablation, or surgery. Outcomes were measured at 6 months after treatment, and results were published in the Sept. 25 New England Journal of Medicine.

After adjustment, disease-specific quality of life was slightly worse in the foam group (P=0.006 compared to surgery) but similar in the laser and surgery groups. This finding may relate to the lower rate of complete ablation in the foam group (55% vs. 84% with surgery and 83% with laser). Generic quality of life was not significantly different in any group. The surgery group had the highest rate of complications at 7%, but the foam group was similar at 6%, and only the laser group was significantly lower, at 1% (P<0.001 compared to surgery).

All 3 treatments had similar clinical efficacy and effects on patients' quality of life, but complications were less frequent after laser treatment and ablation rates were lower with foam, the study authors concluded. The clinical difference of these differences is uncertain, they said. They noted that foam sclerotherapy was used for residual varicosities in a third of the laser group. Also, only 1 center in the study gave laser patients concomitant phlebectomies, a controversial treatment.

The study did not include radiofrequency ablation as a treatment option, and longer follow-up would be needed to assess the durability of the effects observed in this study, the researchers noted.