Surgery Still Best for Varicose Veins

A new study has found that traditional open surgery is still the superior ablation technique for the great saphenous vein, compared to newer alternatives.

Researchers from Imperial College London (UK) compared traditional open surgery to newer alternatives. While traditional open surgery has been performed for over a century, alternative ablation treatments for varicose veins such as endovenous laser ablation, radiofrequency ablation, and foam sclerotherapy have only been in use for 10 years. The limited medical literature available for newer procedures makes comparing recurrence rates difficult. The longest study of endovenous laser ablation available covers only 39 months. Radiofrequency ablation is better documented; a recent three-year study showed it had a significantly worse recurrence rate of 33% as compared to traditional open surgery, which showed a rate of only 23%.

Traditional open surgery is a well-studied procedure, and generally needs to be performed only once. General complications include deep vein thrombosis (0.15%), pulmonary embolus (0.06%), and wound complication, including infection (2.2%).
General complications for radiofrequency ablation include bruising, burns, paraesthesia, clinical phlebitis, and slightly higher rates of deep vein thrombosis (0.57%) and pulmonary embolus (0.17%) than occur after open surgery. Endovenous laser ablation is associated with similar complications, including bruising (24-100%), burns (4.8%), paraesthesia (1-36.5%), and induration along the length of the saphenous vein (55-100%). The findings were presented at the 33rd annual Veith symposium, held in November 2006 in New York (NY, USA).

"The jury remains out on the optimal way in which to treat patients presenting with primary venous incompetence; the endo-luminal techniques definitely have complications,” said lead author Dr. Alun H. Davies. "The long-term recurrence rates have yet to be properly compared between the different modalities.”

The authors found that these facts strongly suggest that newer endovascular procedures should be more thoroughly studied and compared with traditional open surgery, and that the best clinical practice is to empower patients with the information that they need to make a choice among them.



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Imperial College London