A Cochrane review [Abstract] 1 included nine studies on surgery or sclerotherapy for the management of primary varicose veins. The overall quality of the trials included was generally poor. The sample sizes were large (range 150 to 516 participants, mean 261) but power calculations were not reported. Length of follow up for the trials was generally good (range 2 to 10 years, mean 4.86 years). For the majority of participants with significant varicose veins, surgery, whether under local anaesthetic or general anaesthetic, appeared to provide a more long-term benefit when compared with sclerotherapy, in terms of recurrence. There would appear to be a trade-off between lower costs and fewer serious complications, with sclerotherapy showing better early outcomes but surgical treatment showing more durable long-term benefits. The exact lines between the use of one or the other are unclear.
Many of the trials evaluating sclerotherapy and surgery were relatively old and there have been several advances that may make surgical treatment safer, less expensive and more effective. These include day case surgery, stripping to the knee (as opposed to not stripping, or stripping to the ankle) and the use of tourniquets.
A topic in Clinical Evidence 2 summarizes the evidence from four RCTs comparing surgery with sclerotherapy. Significantly more patients were free of recurrence at 2-10 years of follow-up. Clinical Evidence category: Likely to be beneficial.
Comment: The quality of evidence is downgraded by limitations in study quality (e.g. unclear allocation concealment), by inconsistency (heterogeneity in interventions and outcomes) and by indirectness (old-fashioned techniques used in the trials).
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