Surgery versus sclerotherapy for the treatment of varicose veins

Rigby KA, Palfreyman SSJ, Beverley C, Michaels JA

Published Online:

January 21, 2009

Sclerotherapy (injection of a substance into the vein) shows greater benefits than surgery in the short term but surgery has greater benefits in the longer term. Varicose veins are a relatively common problem. Two treatments available are surgery and sclerotherapy. Both involve removal of the vein either by stripping it out (surgery) or by injecting it with a solution that causes it to collapse and be absorbed into the surrounding tissues (sclerotherapy). Neither treatment adversely affects blood flow through the limb. This review found that sclerotherapy was better than surgery in terms of treatment success, complication rate and cost at one year, but surgery was better after five years. However, the evidence was not of very good quality and more research is needed.

Abstract (click to read)

Background:

Varicose veins are a relatively common condition and account for around 54,000 in-patient hospital episodes per year. The two most common interventions for varicose veins are surgery and sclerotherapy. However, there is little comparative data regarding their effectiveness.

Objectives:

To identify whether the use of surgery or sclerotherapy should be recommended for the management of primary varicose veins.

Search strategy:

Thirteen electronic bibliographic databases were searched covering biomedical, science, social science, health economic and grey literature (including current research). In addition, the reference lists of relevant articles were checked and various health services research-related resources were consulted via the internet. These included health economics and HTA organisations, guideline producing agencies, generic research and trials registers, and specialist sites.

Selection criteria:

All studies that were described as randomised controlled trials comparing surgery with sclerotherapy for the treatment of primary varicose veins were identified.

Data collection and analysis:

Two authors independently extracted and summarised data from the eligible studies using a data extraction sheet for consistency. All studies were cross-checked independently by the authors.

Main results:

A total of 2306 references were found from our searches, 61 of which were identified as potential trials comparing surgery and sclerotherapy. However, only nine randomised trials, described in a total of 14 separate papers, fulfilled the inclusion criteria. Fifty trials were excluded and one trial is ongoing and is due for completion in 2004. The trials used a variety of outcome measures and classification systems which made direct comparison between trials difficult. However, the trend was for sclerotherapy to be evaluated as significantly better than surgery at one year; after one year (sclerotherapy resulted in worse outcomes) the benefits with sclerotherapy were less, and by three to five years surgery had better outcomes. The data on cost-effectiveness was not adequately reported.

Authors' conclusions:

There was insufficient evidence to preferentially recommend the use of sclerotherapy or surgery. There needs to be more research that specifically examines both costs and outcomes for surgery and sclerotherapy.

This record should be cited as:

Rigby KA, Palfreyman SSJ, Beverley C, Michaels JA. Surgery versus sclerotherapy for the treatment of varicose veins. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD004980. DOI: 10.1002/14651858.CD004980

Assessed as up to date:

August 24, 2004

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Primary Review Group:

Peripheral Vascular Diseases Group

Health topics:

Heart & circulation > Varicose veins

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Surgery versus sclerotherapy for the treatment of varicose veins

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