***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: INTRODUCTION The most common site of venous reflux is the long saphenous vein ( LSV ) . The preferred treatment for reflux in the LSV is surgical stripping of the LSV . However , the complications of surgical stripping are well documented and undesirable . The constant search for treatment options with less morbidity , which are also cosmetically more acceptable , has result ed in the endovenous treatment for primary varicose veins , developed by VNUS Medical Technologies , Inc ( Sunnyvale , Calif ) . We hereby present our first treatment experiences and propose refinements to the procedure . METHODS Two types of heat-generating endovenous catheters were used to treat incompetence of the LSV with a diameter of up to 12 mm . The procedure was performed on a blood-empty limb . RESULTS Twenty-six limbs , in 26 patients , were treated , and the follow-up period was 1 year . The mean preoperative CEAP score was 4 , and the postoperative score was 1.26 , which was statistically significantly less ( P < .0001 , with Wilcoxon nonparametric matched pair test ) . Five patients had postoperative paresthesia of the saphenous nerve , and one patient had a burn from the procedure . The overall complication rate was 23 % . All complications occurred in the first half of the studied population ( P = .015 , with Fisher exact test ) , indicating the learning curve effect . In one patient ( 3.8 % ) , was total recanalization of the treated segment occurred , one patient ( 3.8 % ) could not be treated at all ( technical failure ) , and one patient ( 3.8 % ) had partial recanalization of the LSV . Eight patients ( 30.8 % ) had closure of the entire LSV but with persisting reflux in the saphenofemoral junction ( SFJ ) . Two patients had a competent SFJ with occlusion of the LSV . In 13 patients ( 50 % ) , closure of both the LSV and the SFJ was seen . The LSV was successfully occluded in 88 % of the patients . CONCLUSION The endovenous catheter should not be used more than 5 to 10 cm below the knee to prevent saphenous nerve damage . Performance of the procedure with bloodlessness is preferable . A result of 88 % of successfully treated LSV segments indicates a promising alternative for surgical stripping of the LSV OBJECTIVE The aim of this r and omized study was to compare a new method of endovenous saphenous vein obliteration ( Closure System , VNUS Medical Technologies , Inc , Sunnyvale , Calif ) with the conventional stripping operation in terms of short-term recovery and costs . METHODS Twenty-eight selected patients for operative treatment of primary greater saphenous vein tributary varicose veins were r and omly assigned to endovenous obliteration ( n = 15 ) or stripping operation ( n = 13 ) . Postoperative pain was daily assessed during the 1st week and on the 14th postoperative day . The length of sick leave was determined . The R AND -36 health survey was used to assess the patient health-related quality of life . The patient conditions were controlled 7 to 8 weeks after surgery , and patients underwent examination with duplex ultrasonography . The comparison of costs included both direct medical costs and costs result ing from lost of productivity of the patients . Costs that were similar in the study groups were not considered in the analysis . RESULTS All operations were successful , and the complication rates were similar in the two groups . Postoperative average pain was significantly less severe in the endovenous obliteration group as compared with the stripping group ( at rest : 0.7 , st and ard deviation [ SD ] 0.5 , versus 1.7 , SD 1.3 , P = .017 ; on st and ing : 1.3 , SD 0.7 , versus 2.6 , SD 1.9 , P = .026 ; on walking : 1.8 , SD 0.8 , versus 3.0 , SD 1.8 , P = .036 ; with t test ) . The sick leaves were significantly shorter in the endovenous obliteration group ( 6.5 days , SD 3.3 days , versus 15.6 days , SD 6.0 days ; 95 % CI , 5.4 to 12.9 ; P < .001 , with t test ) . Physical function was also restored faster in the endovenous obliteration group . The estimated annual investment costs of the closure operation were US $ 3360 . The other direct medical costs of the Closure operation were about $ 850 , and those of the conventional treatment were $ 360 . With inclusion of the value of the lost working days , the Closure treatment was cost-saving for society , and when 40 % of the patients are retired ( or 60 % of the productivity loss was included ) , the Closure procedure became cost-saving at a level of 43 operations per year . CONCLUSION Endovenous obliteration may offer advantages over the conventional stripping operation in terms of reduced postoperative pain , shorter sick leaves , and faster return to normal activities , and it appears to be cost-saving for society , especially among employed patients . Because the procedure is also associated with shorter convalescence , this new method may potentially replace conventional varicose vein surgery BACKGROUND Despite adequate training in the surgical treatment of varicose veins , recurrence continues to be a problem and a burden to the vascular services . A major cause of recurrence is reported to be neo-vascularisation at the sapheno-femoral junction ( SFJ ) . The aim of this study was to compare the incidence of neo-vascularisation at the SFJ following radiofrequency ablation ( RFA ) and open high saphenous tie and stripping ( HSTS ) . MATERIAL S AND METHODS Fifty-one patients ( 55 legs ) underwent st and ardised HSTS as part of a prospect i ve study . These were compared with an age ( range 28 - 83 , mean 54.4 ) and sex ( male : female 31:20 ) matched group of patients treated during the same time period , by the same consultant vascular surgeon , using RFA ( VNUS closure ) . Each patient had a pre-operative duplex scan to confirm SFJ reflux , a one-week scan to confirm successful surgery and a one-year post-operative scan to assess neo-vascularisation . The same vascular technologist performed all scans . Neo-vascularisation was identified by the presence of refluxing tortuous vessels arising from the area of the SFJ . RESULTS AND CONCLUSION Six of 55 ( 11 % ) legs in the open surgery group showed clear evidence of tortuous refluxing veins related to the SFJ . None of the 55 in the RFA group showed any neo-vascularisation at the SFJ ( Fischer exact test P = 0.028 ) . Further r and omised controlled trials are necessary to confirm these observations The study was planned to evaluate efficacy and costs of endovascular sclerotherapy ( ES ) in comparison with surgery and surgery associated with sclerotherapy in a prospect i ve ( 10-year follow-up ) , good- clinical - practice study . Patients with varicose veins and pure , superficial venous incompetence were included . Of the patients r and omized into the three groups 39 ( group A ) were treated with ES , 40 ( B ) with surgery + sclerotherapy , and 42 with surgery only ( C ) . Surgery consisted of ligation of the SFJ ( saphenofemoral junction ) and of incompetent veins detected with color duplex . Of the preselected 150 patients , 121 subjects entered the study ; 96 completed the 10-year follow-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 treated 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 + scle rotherapy 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 obstruc tion 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 sclerotherapy was 122 % of surgery only .  Endovascular sclerotherapy is an effective , cheaper treatment option , but surgery after 10 years is superior OBJECTIVE This study aim ed to assess the outcome of endoluminal thermal ablation ( VNUS ) and traditional redo groin surgery ( RGS ) and long saphenous vein ( LSV ) stripping in patients with bilateral recurrent long saphenous varicose veins . METHODS This was a r and omised patient controlled double blind study . Sample size calculations required 16 patients . Their median age was 54 and 11 were women . The median CEAP class was 3 . At operation one leg , chosen at r and om , was treated with VNUS and avulsions using intra-operative duplex control . The other leg was treated with traditional RGS , exposure of the femoral vein , stripping of the LSV and multiple avulsions . Post-operatively patients completed 10 cm visual analogue scales for pain and bruising . Digital Image analysis was used to objective ly assess bruising . Statistical analysis was done using Wilcoxon signed rank test for paired data . Results are expressed as median values ( inter-quartile ranges ) . RESULTS Time to perform VNUS  was 25.5 ( 20.5 - 31.3 ) min compared with 40 ( 34.5 - 45.5 ) min it took for RGS ( p=0.02 ) . Pain score for VNUS was 1.7 ( 0.2 - 4 ) , significantly lower than that for RGS 3.8 ( 0.6 - 6.3 ) ( p=0.02 ) . Bruise score for VNUS was 1.7 ( 0.4 - 4.4 ) , and that for RGS was 5.2 ( 2.6 - 7 ) ( p=0.03 ) . All LSVs were sealed by VNUS at duplex follow up . Three legs in the RGS group and two in the VNUS group had a minor complication . CONCLUSIONS VNUS caused less pain and bruising and was performed more quickly than RGS . VNUS should be considered the treatment of choice for recurrent long saphenous varicose veins PURPOSE This study was design ed as a prospect i ve multicenter r and omized comparison of procedure-related complications , patient recuperation , and quality -of-life outcomes between patients undergoing vein stripping with high ligation and patients undergoing great saphenous vein ( GSV ) obliteration with temperature-controlled radiofrequency ablation without adjunctive high ligation ( Closure procedure ) . METHODS Eighty-five patients ( 86 limbs ) from five sites ( France , 2 ; Austria , 1 ; United States , 2 ) were r and omly allocated to undergo radiofrequency obliteration ( RFO ) or stripping and high ligation ( S&L ) . Final analysis included data for 44 limbs in the RFO group and 36 limbs in the S&L group . Follow-up examinations were performed at 72 hours , 1 week , 3 weeks , and 4 months . All patients completed the CIVIQ2 quality -of-life ( QOL ) question naire and underwent clinical and ultrasound examinations at each follow-up visit . RESULTS Immediate success on the day of treatment was reported for 95 % ( 42 of 44 ) of limbs in the RFO group and 100 % ( 36 of 36 ) of limbs in the S&L group . In seven RFO limbs ( 16.3 % ) a scan obtained 72 hours after the procedure showed flow in the proximal GSV . Five of these segments had reflux in the open segment . At 1 week two of these closed , and an additional segment closed at 3 weeks . In no cases did flow reappear after complete occlusion of the GSV . Time to return to normal activities was significantly less in the RFO group ( mean , 1.15 days ; 95 % confidence interval [ CI ] , 0.05 - 2.34 ) compared with the S&L group ( mean , 3.89 days ; CI , 2.67 - 5.12 ; P = .02 ) . In the RFO group , 80.5 % of patients returned to routine activities of daily living within 1 day , compared with 46.9 % of patients in the S&L group ( P < .01 ) . Patients in the RFO group were able to return to work in 4.7 days ( CI , 1.16 - 8.17 ) , compared with 12.4 days ( CI , 8.66 - 16.23 ) for the S&L group ( P < .05 ) . Analysis of the QOL surveys showed statistically significant differences in favor of the RFO group for global score and pain score during follow-up . The magnitude of the difference , however , progressively decreased between 1 week and 4 months . CONCLUSIONS In the absence of significant complications , such as deep vein thrombosis and pulmonary embolism , severe neuritic sequelae , and skin burns , there are significant early advantages to endovascular obliteration of the GSV compared with conventional vein stripping Endovenous laser therapy ( EVLT ) is a minimally invasive treatment for varicose veins . This study compares early quality -of-life ( QoL ) outcomes following EVLT and surgery .  Two nonr and omized groups were studied : an EVLT group with 70 patients , median age 49 ( interquart 
    Output:
    
Serious adverse events were rare .
Minor adverse events were more common but generally self-limiting .
All treatments displayed levels of effectiveness depending on the extent of the vein in question .
Short-term advantages appeared to be associated with sclerotherapy and endovenous treatments , and long-term effectiveness was more apparent following surgical intervention .
Evidence suggests conservative therapy is less effective than sclerotherapy and surgery for the treatment of varicose veins .
Sclerotherapy and surgery both appear to have a place in the management of varicose veins .
Sclerotherapy and phlebectomy  may also be more appropriate in patients with minor superficial varicose veins not related to reflux of the saphenous system or as a post- or adjunctive treatment to other procedures , such as surgery .
Current evidence suggests endovenous laser therapy and radiofrequency ablation are as safe and effective as surgery  , particularly in the treatment of saphenous veins .