***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES Comparison of Reverse Foam Sclerotherapy of the great saphenous vein ( GSV ) combed with sapheno-femoral junction ( SFJ ) ligation to st and ard ( Babcock ) stripping and invagination ( Pin ) stripping in a prospect i ve clinical series . DESIGN Prospect i ve clinical series . MATERIAL S AND METHODS 90 consecutive limbs of 82 patients with incompetence of the GSV result ing in varicose veins were prospect ively r and omised into 3 groups of 30 , treated by SFJ ligation and either reverse foam sclerotherapy , st and ard stripping or invagination stripping of the GSV . Outcomes were assessed post-operatively and at 2-weeks follow-up . Peri-operative blood loss ( 24 hrs ) , analgesic requirement , bruising and residual varicosities were assessed . Bruising was assessed by both patients and independent assessors using question naires . RESULTS SFJ ligation plus reverse foam sclerotherapy of the GSV was associated with significantly less blood loss , bruising and post-op discomfort than either of the stripping techniques . ( p<0.001 , Mann-Whitney ) CONCLUSION St and ard stripping of the GSV and invagination stripping are not associated with major discomfort and problems in the early post-operative period . SFJ ligation and GSV reverse foam sclerotherapy yielded greater patient satisfaction with less post-op bruising and discomfort and reduced analgesic requirements Endovenous laser ablation ( EVLA ) and radiofrequency ablation ( RFA ) are both associated with excellent technical , clinical and patient‐reported outcomes for the treatment of varicose veins . The aim of this study was to compare the techniques in a r and omized clinical trial OBJECTIVES To assess the quality of life of patients undergoing sapheno-femoral junction ( SFJ ) ligation and long saphenous vein stripping ( LSV )  , using two different techniques . DESIGN Prospect i ve , r and omised trial . MATERIAL S AND METHODS Eighty patients were recruited and r and omised to either  Perforate Invagination ( PIN ) stripping ( 43 ) or Conventional stripping ( 37 ) . Patients completed the Short Form 36 ( SF-36 ) and EuroQol ( EQ ) question naires preoperatively , and postoperatively at 6 weeks and 6 months . RESULTS Bodily pain , role function and physical summary were significantly improved at 6 months in the PIN stripping group . In the Conventional group , bodily pain and physical function were similarly improved , but not role function . EQ global quality of life was significantly and progressively improved at 6 weeks and 6 months in the PIN group ( global score p<0.003 ; self-rated score p < 0.001 ) . In the Conventional group there was no overall improvement in global score or self-rated health . CONCLUSIONS Primary varicose vein surgery is associated with significant and progressive improvements in quality of life scores . Whilst overall quality of health does improve in the Conventional group , this appears to be to a lesser extent than in the PIN group BACKGROUND Although endovenous laser ablation for varicose veins is replacing surgical stripping , proper economic evaluation with adequate follow-up in a r and omised clinical trial is important for considered policy decisions regarding the implementation of new techniques . METHODS Data from a r and omised controlled trial comparing cryostripping and endovenous laser ablation in 120 patients were combined to study Short Form ( SF ) 6D outcome , costs and cost-effectiveness 2 years after treatment . Incremental cost per quality -adjusted life year ( QALY ) gained 2 years after treatment was calculated using different strategies , and uncertainty was assessed with bootstrapping . RESULTS Over the total study period , mean SF-6D scores improved slightly from 0.78 at baseline to 0.80 at 2 years for patients who underwent cryostripping and from 0.77 to 0.79 for patients who underwent endovenous laser .  QALY ( SF-6D ) was 1.59 in patients who underwent cryostripping and 1.60 in patients who underwent endovenous laser 2 years after treatment . The costs of cryostripping and endovenous laser  per patient were euro 2651 and euro 2783 , respectively . Bootstrapping indicated that cryostripping was associated with an incremental cost-effectiveness ratio of euro 32 per QALY gained . With regard to different strategies , outpatient cryostripping was less costly and more effective 2 years after treatment . CONCLUSION In this study , in terms of costs per QALY gained , outpatient cryostripping appeared to be the dominant strategy , but endovenous laser yielded comparable outcomes for a relatively little additional cost OBJECTIVES Comparison of sapheno-femoral ligation and stripping ( SFL/S ) versus endovenous laser ablation ( EVLA , 980-nm ) in the treatment of great saphenous vein ( GSV ) insufficiency , using local tumescent anaesthesia . DESIGN R and omised , single centre trial . MATERIAL S AND METHODS Patients with GSV incompetence and varicose veins were r and omised to either SFL/S or EVLA . At days 1 , 2 , 3 , 7 , 10 , and 14 post-treatment , patients completed question naires on pain and quality of life . Recurrent varicose veins were evaluated by Duplex ultrasound ( DUS ) performed at 1 and 6 weeks , and 6 and 12 months . RESULTS 130 legs in 121 patients were treated by SFL/S  ( n=68 ) or EVLA ( n=62 ) . Significantly more post-treatment pain was noted after EVLA at days 7 , 10 and 14 ( p<0.01 ; p<0.01 ; p=0.01 ) , more hindrance in mobility at days 7 ( p<0.01 ) and 10 ( p=0.01 ) , and in self care ( p=0.03 ) and daily activities ( p=0.01 ) at day 7 compared to SFL/S. DUS at 1-year follow-up showed 9 % recurrences ( 5/56 ) after EVLA and 10 % ( 5/49 ) after SFL/S. CONCLUSION Both SFL/S and EVLA , using local tumescent anaesthesia , were well tolerated , with no difference in short-term recurrence rate . In the second week after EVLA , patients experienced significantly more pain result ing in restricted mobility , self care and daily activity compared to Introduction : Chronic venous insufficiency is the most common vascular disease in the adult population . However , r and omized clinical trials ( RCTs ) comparing therapeutic options are limited . Patients and Methods : A total of 180 patients with saphenofemoral junction and great saphenous reflux detected on duplex were r and omized to either ultrasound-guided radiofrequency ablation ( RFA ) or st and ard surgical treatment .  The study participants blindly chose an assignment card that placed them in either group A ( ultrasound-guided RFA of the great saphenous vein [ GSV ] ; n = 90 ) ; or group B ( surgical management n = 90 ) . Patients were followed up for 24 months . Results : The primary occlusion rate in group A was 94.5 % versus 100 % in group B. Radiofrequency ablation had a lower overall complication rate ( P = .02 ) and shorter post-intervention hospital stay ( P = .001 ) . Kaplan-Meier analysis showed no significant differences in recurrence rates at 24 months follow-up ( P = .45 ) . Radiofrequency ablation was significantly more expensive ( P = .003 ) . Conclusion : Great saphenous vein occlusion was achieved efficiently in 94 % of our group using RFA with minimal complications and obvious advantages as compared to st and ard surgery INTRODUCTION This study compares the outcome 3 years after treatment of varicose veins by endovenous laser ablation ( EVLA ) , radiofrequency ablation , ultrasound-guided foam sclerotherapy ( UGFS ) , or surgery by assessing recurrence , Venous Clinical Severity Score ( VCSS ) , and quality of life ( QOL ) . METHODS A total of 500 patients ( 580 legs ) were r and omized to one of the three endovenous treatments or high ligation and stripping of the great saphenous vein ( GSV ) .  Follow-up included clinical and duplex ultrasound examinations and  VCSS and QOL question naires . Kaplan-Meier ( KM ) life-table analysis was used . P values below .05 were considered statistically significant . RESULTS At 3 years , eight ( KM estimate , 7 % ) , eight ( KM estimate , 6.8 % ) , 31 ( KM estimate , 26.4 % ) , and eight ( KM estimate , 6.5 % ) of GSVs recanalized or had a failed stripping procedure ( more than 10 cm open refluxing part of the treated GSV ; CLF , EVLA , UGFS , and stripping , respectively ; P < .01 ) . Seventeen ( KM estimate , 14.9 % ) , 24 ( KM estimate , 20 % ) , 20 ( KM estimate , 19.1 % ) , and 22 ( KM estimate , 20.2 % ) legs developed recurrent varicose veins ( P = NS ) . The patterns of reflux and location of recurrent varicose veins were not different between the groups . Within 3 years after treatment , 12 ( KM estimate , 11.1 % ) , 14 ( KM estimate , 12.5 % ) , 37 ( KM estimate , 31.6 % ) , and 18 ( KM estimate , 15.5 % ) legs were retreated in the CLF , EVLA , UGFS , and stripping groups , respectively ( P < .01 ) . VCSS , SF-36 , and Aberdeen QOL scores improved significantly in all the groups with no difference between the groups . CONCLUSIONS All treatment modalities were efficacious and result ed in a similar improvement in VCSS and QOL . However , more recanalization and reoperations were seen after UGFS Endovenous laser ablation ( EVLA ) is a popular minimally invasive treatment for  varicose veins .  Surgical treatment , featuring junctional ligation and inversion stripping , has shown excellent clinical and cost effectiveness . The clinical effectiveness of both treatments was compared within a r and omized trial BACKGROUND Great saphenous vein ( GSV ) incompetence is the most common cause of superficial venous insufficiency .  Radiofrequency catheter ablation ( RFA ) is superior to conventional ligation and stripping , and endovenous laser treatment ( EVL ) has emerged as an effective alternative to RFA . This r and omized study evaluated RFA and EVL for superficial venous insufficiency due to GSV incompetence and compared early and 1-year results . METHODS Between June 2006 and May 2008 , patients with symptomatic primary venous insufficiency due to GSV incompetence were r and omized to RFA or EVL .  Patients with bilateral disease were r and omized for treatment of the first leg and received the alternative method on the other . Pretreatment examination included a leg assessment using the Venous Clinical Severity Score ( VCSS ) and CEAP classification . Patients completed the Chronic Venous Insufficiency Question naire 2 ( CIVIQ2 ) . RFA was performed with the ClosurePlus system ( VNUS Medical Technologies , Sunnyvale , Calif ) . EVL was performed with the EVLT system ( AngioDynamics Inc , Queensbury , NY ) . Early ( 1-week and 1-month ) postoperative results of pain , bruising , erythema , and hematoma were recorded . Duplex ultrasound ( DU ) imaging was used at 1 week and 1 year to evaluate vein status . VCSS scores and CEAP clinical class were recorded at each postoperative visit , and quality of life ( QOL ) using CIVIQ2 was assessed at 1 month and 1 year . RESULTS The study enrolled 118 patients ( 141 limbs ) : 46 ( 39 % ) were r and omized to RFA and 48 ( 40 % ) to EVL , and 24 ( 20 % ) had bilateral GSV incompetence . At 1 week , one patient in the RFA group had an open GSV and was deemed a failure . More bruising occurred in the EVL group ( P = .01 ) at 1 week , but at 1 month , there was no difference in bruising between groups . At 1 year , DU imaging showed evidence of recanalization with reflux in 11 RFA and 2 EVL patients ( P = .002 ) . The mean VCSS score change from baseline to 1 week postprocedure was higher for RFA than EVL ( P = .002 ) , but there was no difference between groups at 1 month ( P = .07 ) and 1 year ( P = .9 ) . Overall QOL mean score improved over time for all patients ( P < .001 ) . CEAP clinical class scores of > or=3 were recorded in 21 RFA ( 44 % ) and 24 EVL patients ( 44 % ) pretreatment , but at 1-year , 9 RFA ( 19 % ) and 12 EVL patients ( 24 % ) had scores of > or=3 ( P < .001 ) . This represented a significant improvement in all patients compared with baseline . CONCLUSION Both methods of endovenous ablation effectively reduce symptoms of superficial venous insufficiency .  EVL is associated with greater 
    Output:
    
Differences between treatments were negligible in terms of clinical outcomes , so the treatment with the lowest cost appears to be most cost-effective .
Total FS costs were estimated to be lowest , and FS was marginally more effective than surgery .
However , relative effectiveness was sensitive to the model time horizon .
Threshold analysis indicated that EVLA and RFA might be considered cost-effective if their costs were similar to those for surgery .
This assessment of currently available evidence suggests there is little to choose between surgery and the minimally invasive techniques in terms of efficacy or safety , so the relative cost of the treatments becomes one of the deciding factors .