This systematic review compares various endovenous treatment methods for varicose veins, including endovenous laser ablation (EVLA), radiofrequency obliteration (RFO), and foam sclerotherapy (FS). Results suggest EVLA and RFO are similarly effective with low recurrence rates, whereas FS shows higher recurrence, particularly with saphenofemoral incompetence. Overall, these treatments demonstrate good safety and efficacy, with a need for further long-term randomized clinical trials.

1. Review of Randomized
Controlled Trials
Comparing
Endovenous Thermal
and Chemical Ablation
EDWARD G MACKAY MD
IVC 2014

2. Systematic review and meta-analysis of
endovenous radiofrequency obliteration,
endovenous laser therapy, and foam
sclerotherapy for primary varicosis
 Luebke T(1), Brunkwall J
 (1)Division of Vascular Surgery, University of Cologne, Cologne, Germany
 J Cardiovasc Surg (Torino). 2008 Apr;49(2):213-33
 Twenty-nine EVLT studies, 32 RFO studies and 22 FS trials were included between 1970 and 2007
 RFO was associated with the worst short and long-term safety and efficacy results compared to EVLT and
FS regarding ''complete occlusion at the end of follow-up'',''phlebitis'', ''deep vein thrombosis'', and
''paraesthesia‘
 ‘Foam sclerotherapy of varicose veins is associated with a higher recurrence rate in patients with
saphenofemoral incompetence compared to the rates after EVLT or RFO treatment
 EVLT, RFO, and FS seem to be safe and effective modalities with good short and mid-term
 Need RCT and long term follow up

3. J Vasc Surg. 2008 Oct;48(4):940-6
Endovenous laser and echo-guided foam
ablation in great saphenous vein reflux:
one-year follow-up results
 Gonzalez-Zeh R(1), Armisen R, Barahona S. Santiago, Chile
 endovenous laser ablation achieved higher occlusion rates than echo-guided
chemical ablation with foam after one year follow-up (93vs77%)
 Similar improvement in VCSS

4. Cochrane Database Syst Rev. 2011 Oct
5;(10)
 Endovenous ablation (radiofrequency and laser) and foam sclerotherapy
versus conventional surgery for great saphenous vein varices.
 Thirteen reports from five studies with a combined total of 450 patients
were include
 Recurrence following RFA showed no difference when compared with
surgery
 clinical trial evidence suggests RFA and EVLT are at least as effective as
surgery
 insufficient data to comment on USGFS Further randomised trials are
needed

5. Randomized Clinical Trial comparing EVLA,
RFA,FS and stripping for Greater
Saphenous varicose veins
 Rasmussen LH, Lawaetz M, Bjoern A, Eklof G Vein Centres, Naestved, Denmark
 Br J Surg. 2011 Aug;98(8):1079-87
 Five hundred consecutive patients (580 legs) randomized to EVLA, RFA, FS or stripping
 1 year recurrent reflux EVLA(5.8%), RFA(4.8%), FS(16.3%) and stripping(4.8%)
 Complications one PE with FS and one DVT with stripping
 Pain scores(0-10) EVLA(2.58), RFA(1.21), FS(1.6) and stripping(2.25)
 Return to normal function EVLA(2),RFA(1),FS(1),and stripping(4)
 Return to work EVLA(3.6),RFA(2.9),FS(2.9) and stripping(4.3)
 Disease-specific quality-of-life and Short Form 36 (SF-36(®)) scores had improved in all groups by 1-year
follow-up. In the SF-36(®) domains bodily pain and physical functioning, the radiofrequency and foam
groups performed better in the short term than the other

6. Interim results on abolishing reflux
alongside a randomized clinical trial on
laser ablation with phlebectomies versus
foam sclerotherapy
 Lattimer CR1, Kalodiki E et al
 Int Angiol. 2013 Aug;32(4):394-403
 1Department of Medicine, Science and Technology, Imperial College, London, UK.
 Ultrasound, VCSS, AVVQ, Saphenous Treatment Score (STS)
 Adjuvant sclerotherapy allowed
 GSV occlusion EVLT 95.5% vs 67.4% for UGFS
 VCSS, AVVQ, STS similar
 Aduvant slcero in 41% of UGFS legs vs 20% EVLA with 4.7 total treatments

7. Comparing endovenous laser ablation,
foam sclerotherapy, and conventional
surgery for great saphenous varicose veins.
 Biemans AA1, Kockaert M et al; 1Department of Dermatology, Erasmus Medical Center, Rotterdam,
The Netherlands
 J Vasc Surg. 2013 Sep;58(3):727-34
 240 consecutive patients with primary symptomatic great saphenous vein reflux were randomized to
EVLA, UGFS, or stripping
 1 year technical success EVLA (88.5%), followed by CS (88.2%) and UGFS (72.2%)
 All groups showed significant (P < .001) improvement of EuroQol 5 and Chronic Venous Insufficiency
Quality-of-Life Questionnaire scores after therapy

8. Conclusions
 Amazingly consistent results
 Reflux free EVLA and RFA very similar both in the mid 90% with FS high 60 to low 80’s
 Patient reported outcomes very equal with slight favor to FS and RFA in the early post op