Varicose Veins Treatment -- Surgery or laser ablation superior to foam sclerotherapy

UK: Treatment of varicose veins with laser ablation or surgery resulted in a better quality of life at 5 years than treatment with foam sclerotherapy, according to results from a recent study published in the New England Journal of Medicine.

Ultrasound-guided foam sclerotherapy and endovenous laser ablation are recommended as an alternative to surgery for treatment of primary varicose veins, but their comparative effectiveness remains ambiguous.

Julie Brittenden, the Institute of Cardiovascular Research, University of Glasgow, Glasgow, United Kingdom, and colleagues compared the outcomes of laser ablation, foam sclerotherapy, and surgery in a randomized, controlled trial involving 798 participants with primary varicose veins at 11 centres in the UK.

Primary outcomes at 5 years were the disease-specific quality of life and generic quality of life, as well as cost-effectiveness based on models of expected costs and quality-adjusted life-years (QALYs) gained that used data on participants’ treatment costs and scores on the EuroQol EQ-5D questionnaire.

595 (75%) of the 798 trial participants completed the varicose vein-specific questionnaire.

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Key findings include:

• After adjustment for baseline scores and other covariates, scores on the Aberdeen Varicose Vein Questionnaire (on which scores range from 0 to 100, with lower scores indicating a better quality of life) were lower among patients who underwent laser ablation or surgery than among those who underwent foam sclerotherapy (effect size [adjusted differences between groups] for laser ablation vs. foam sclerotherapy, −2.86 and for surgery vs. foam sclerotherapy, −2.60).


• Generic quality-of-life measures did not differ among treatment groups.


• At a threshold willingness-to-pay ratio of £20,000 ($28,433 in U.S. dollars) per QALY, 77.2% of the cost-effectiveness model iterations favored laser ablation.


• In a two-way comparison between foam sclerotherapy and surgery, 54.5% of the model iterations favored surgery.

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The results showed that "in all three groups, quality of life 5 years after treatment was improved from baseline," the team concluded. "However, there were clinically important between-group differences in disease-specific quality of life that favored laser ablation and surgery over foam sclerotherapy. Laser ablation was similar to surgery with respect to the quality of life and of the three treatments had the highest chance of being cost-effective."

The results showed that 58% of the laser group reported no varicose veins at 5 years, as compared with 54% for the surgery group and 47% for the sclerotherapy group. The difference between laser and sclerotherapy achieved statistical significance (odds ratio 0.59, 95% CI 0.41-0.85). Additionally, 14% of the sclerotherapy group, 11% of the laser group, and 7% of the surgery group had undergone additional treatment at 5 years.