#VisualAbstract: Five-Year Outcomes of a Randomized Trial of Treatments for Varicose Veins

1. In patients with primary varicose veins followed for 5 years after treatment, those randomized to receive laser ablation or surgery reported greater improvements in disease-specific quality-of-life compared to patients who received ultrasound-guided foam sclerotherapy.

2. Cost-effectiveness models favored laser ablation over both foam sclerotherapy and surgery.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Minimally invasive alternatives to surgery for varicose veins, including laser ablation and ultrasound-guided foam sclerotherapy, have been studied out to 3 years, but data regarding quality-of-life and recurrence rates among the three procedures are limited at the 5-year interval. The Comparison of Laser, Surgery, and Foam Sclerotherapy (CLASS) trial assessed quality-of-life and cost effectiveness of laser ablation, foam sclerotherapy, and surgery with follow-up out to 5 years. The primary outcome of patient-reported disease-specific quality-of-life ratings at 5 years, as assessed by the Aberdeen Varicose Vein Questionnaire (AVVQ), indicated higher quality-of-life for the laser ablation and surgery groups than the foam sclerotherapy group. Using a cost effectiveness per quality-adjusted life-year (QALY) model, laser ablation had a higher cost-effectiveness than foam sclerotherapy or surgery, with foam sclerotherapy and surgery showing similar cost-effectiveness outcomes.

This randomized trial provides evidence that laser ablation and surgery are superior to foam sclerotherapy toward improving quality-of-life in patients with varicose veins, and that laser ablation is usually more cost-effective than foam sclerotherapy or surgery. Limitations include lack of a sham procedure, no single or double blinding, and the notable quantity of missing data at the 5-year timepoint.

Click to read the study in NEJM

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