In a controlled clinical investigation 516 patients with previously untreated saphenous varices were divided into three treatment groups according to a stratified group comparative design. The patients in treatment group 1 underwent a radical operation under full anaesthesia; the patients in group 2 were treated by means of minor operations followed by injection/compression therapy; the patients in group 3 were treated by means of injection/compression therapy alone. The results were evaluated both objectively and subjectively 3 months and 3 years after treatment, the follow-up being 100 per cent and 98.1 per cent complete at those times. With regard to the period of disability among those patients with jobs outside the home (63.8 per cent), there was a statistically significant difference between the three groups, the median period of disability being 14.2, 7.6 and 0 days respectively. In all three treatment groups the results were worse after 3 years than after 3 months, but the difference was significantly less following radical operation than after combined treatment, and significantly less following combined treatment than after injection/compression therapy alone. The patients were randomized and treated by the author and the results of treatment were evaluated by the author and partly controlled by another investigator.



It is concluded that the primary treatment for incompetence of the saphenous veins should be a radical operation.

The value of different forms of treatment for varicose veins.

A prime requisite of successful varicose vein surgery is a detailed clinical examination. This reveals a new test for short saphenous incompetence and shows that 14 per cent of varices stem from a saphenopopliteal reflux. The intimate details of juxtafemoral and juxtapopliteal ligation are emphasized and the common causes of failure pointed out. The technique of “scarless” varicose vein surgery is described. A 6-10-year follow-up of some 2000 patients reveals an overall recurrence rate of 7 per cent.

The surgical cure of primary varicose veins.

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

Surgery versus sclerotherapy for the treatment of varicose veins.

Varicose veins: a comparison of surgery and injection/compression sclerotherapy

The modern injection-compression sclerotherapy, as described by Fegan of Ireland and Sigg of Switzerland, bears little resemblance to the injection treatment of varicose veins as used in the United States in the 1940s. Sotredecol (sodium tetradecyl sulfate) is the agent injected, and no more than 0.5 ml is used at any one site. The sites picked are those of the incompetent perforator veins which are found by careful physical examination. The injection is made into the emptied vein with the leg raised, and a firm compression dressing is applied as the injections are made from below cephalad. The compression bandage is worn for 3 weeks. Randomized studies that compared surgery and injection-compression sclerotherapy in the treatment of varicose veins have shown little difference in the end results. The overall cost, including hospitalization, work days lost, and complications, are greater with surgery. A series of 66 patients has been analyzed.

J.M. Weddell

Papers

Cost of treating varicose veins