Treatment options for primary varicose veins - A review

Compression hosiery improves symptoms and haemodynamics and is useful in patients who are either unfit or decline more invasive therapy. Long-term efficacy is limited by poor compliance. Sclerotherapy is effective in the absence of LSV reflux and is both cheap and relatively non-invasive. Ultrasound-guided long saphenous sclerotherapy seems to have disappointingly high recurrence rates compared to data from non-randomised studies of other endovenous techniques. Although there are no placebo-controlled trials, surgical treatment for varicose veins seems to: i. relieve symptoms and improve disease-related quality of life ii. have a role in the secondary prevention of venous ulceration iii. provide a cosmetic improvement which is almost certainly operator-dependent iv. be associated with minor complications which are relatively common v. be associated with major neurosensory or vascular complications which are very rare vi. be associated with a definite but variable risk of recurrence. Outcome data on the newer, less invasive interventions is generally less extensive than that for conventional surgery and is largely limited to small, non-randomised studies with limited follow-up. However, both radiofrequency and endovenous laser ablation of the LSV have been approved by the National Institute for Clinical Excellence (NICE) for routine clinical use in the UK. The clinical results for both techniques are similar although long-term follow-up is required. Whilst radiofrequency ablation it is usually performed under general anaesthetic and is limited to LSV of <12 mm diameter, endovenous laser treatment is performed under local anaesthetic and is equally effective for veins of >12 mm diameter. As a result, it offers potential benefits in terms of cost (disposables, staffing, work absence) and recovery time. Of the other techniques reviewed CHIVA appears both complex and to have high recurrence rates, diathermy sclerosis and cryosurgery are associated with their own complications and confer no obvious advantage whilst transilluminated powered phlebectomy (TriVex™) seems to increase both operative time, cost, and haematoma development without major benefit in most patients. Although it might be useful in selected patients with skin changes and friable veins (particularly recurrences) NICE have indicated that there are still uncertainties regarding both efficacy and safety and it is therefore inappropriate for routine clinical use. © 2005 Elsevier Ltd. All rights reserved.