Endovascular sclerotherapy, surgery, and surgery plus sclerotherapy in superficial venous incompetence: A randomized, 10-year follow-up trial - Finalresults

The study was planned to evaluate efficacy and costs of endovascular sclero therapy (ES) in comparison with surgery and surgery associated with sclerot herapy in a prospective (10-year follow-up), good-clinical-practice study. Patients with varicose veins and pure, superficial venous incompetence were included. Of the patients randomized into the three groups 39 (group A) we re treated with ES, 40 (B) with surgery + sclerotherapy, and 42 with surger y only (C). Surgery consisted of ligation of the SFJ (saphenofemoral juncti on) and of incompetent veins detected with color duplex. Of the preselected 150 patients, 121 subjects entered the study; 96 completed the 10-year fol low-up (mean age 52.6 +/- 6 years; 51 men, 45 women), Dropouts were due to nonmedical problems. At 10 years no incompetence was observed in subjects t reated with SPJ ligation (B and C), In the ES group 18.8% of the SFJs were patent and incompetent and in 43.8% of limbs the distal (below-knee) venous system was still incompetent [16.1% in the surgery + sclerotherapy group ( p < 0.05) and 36% in the group treated with surgery only (p < 0.05 vs B and 0.05 vs A)]. Color duplex of the long saphenous vein indicated atrophy or obstruction of a segment (average 6.7 cm) after SFJ ligation (4.2 cm after ES), The cost of ES was 68% of surgery while the cost of surgery and sclero therapy was 122% of surgery only. Endovascular sclerotherapy is an effectiv e, cheaper treatment option, but surgery after 10 years is superior.