Varicose veins are enlarged tortuous superficial veins at least 3mm in diameter that usually affect the great (GSV) and small (SSV) saphenous veins in the lower limbs. Varicose veins are caused by decreased elasticity of the vein wall and poorly functioning valves within the vein, resulting in blood pooling in the veins and vein enlargement. Surgery, including saphenous vein ligation and stripping, has been standard therapy for the treatment of varicose veins. Surgery, however, is invasive and may be associated with a greater incidence of complications and slower recovery relative to newer treatments such as endovascular thermal ablation (EVTA). Sclerotherapy is also a common therapy for smaller varices (< 4mm) in patients with less severe disease, but multiple treatments are often required. EVTA, which includes laser (EVLT) and radiofrequency ablation (RFA), are therapies that are less invasive than surgery, and preliminary data suggest that EVTA is associated with similar treatment success rates with reduced recovery time and complications relative to surgery. EVTA requires specialized equipment and training, however, and it is unclear whether long-term clinical effectiveness, safety, and cost-effectiveness is improved with EVTA therapies relative to traditional therapies including surgery and sclerotherapy. In addition, it is unclear whether there are differences in terms of effectiveness and complications between EVLT and RFA. The purpose of this review is to provide an update of a Rapid Response report produced by CADTH in 2011. It compares the available evidence for the treatment of uncomplicated varicose veins, with a focus on endovascular thermal ablation compared with surgery or sclerotherapy, and EVLT compared with RFA, in terms of clinical effectiveness, safety, cost-effectiveness, and evidence-based guidelines.
- Pages
- 34
- Published in
- Ottawa, Ontario
