***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 
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    Input: Three techniques for treatment of chronic venous incompetence on an out patients basis were compared in a r and omised study . One hundred thirty eight limbs ( 107 patients ) with superficial venous incompetence were r and omly treated with the dentist 's technique ( DT ) [ Group A , 44 limbs ] , compression sclerotherapy ( CS ) [ Group B , 45 limbs ] or the SAVAS ( section en Ambulatoire des Varices avec Sclérothérapie ) technique [ Group C , 49 limbs ] . Patients were evaluated and followed up ( every year for 4 years ) with ambulatory venous pressure ( AVP ) measurements and Quantum angiodynography ( colour duplex scanning ) . DT consisted in the section under local anesthesia of incompetent veins . CS was done injecting polidocanol 3 % with compression applied for 4 weeks . The SAVAS was done with a combination of DT and CS with section of the incompetent veins under local anesthesia and retro grade injection in the distal vein of polidocanol 3 % . With this type of injection only incompetent veins were perfused . After 4 years there was a significantly lower refilling time ( RT ) with AVP in the SAVAS group ( 21 sec ) . RT was 13 sec in group B and 16 in A. The number of significantly incompetent residual veins was in average 0.5 in the SAVAS group , significantly lower than in the other two groups . Also the average cost per treated limb was significantly lower in the SAVAS group ( 917 francs in comparison with 1100 in group A and 1211 in group B ) . In conclusion considering the four year follow up , the SAVAS technique is a more effective treatment of superficial venous incompetence , its hemodynamic value is superior to sclerotherapy alone and its costs are lower BACKGROUND Ultrasound-guided foam sclerotherapy and endovenous laser ablation are widely used alternatives to surgery for the treatment of varicose veins , but their comparative effectiveness and safety remain uncertain . METHODS In a r and omized trial involving 798 participants with primary varicose veins at 11 centers in the United Kingdom , we compared the outcomes of foam , laser , and surgical treatments . Primary outcomes at 6 months were disease-specific quality of life and generic quality of life , as measured on several scales . Secondary outcomes included complications and measures of clinical success . RESULTS After adjustment for baseline scores and other covariates , the mean disease-specific quality of life was slightly worse after treatment with foam than after surgery ( P=0.006 ) but was similar in the laser and surgery groups . There were no significant differences between the surgery group and the foam or the laser group in measures of generic quality of life . The frequency of procedural complications was similar in the foam group ( 6 % ) and the surgery group ( 7 % ) but was lower in the laser group ( 1 % ) than in the surgery group ( P<0.001 ) ; the frequency of serious adverse events ( approximately 3 % ) was similar among the groups . Measures of clinical success were similar among the groups , but successful ablation of the main trunks of the saphenous vein was less common in the foam group than in the surgery group ( P<0.001 ) . CONCLUSIONS Quality -of-life measures were generally similar among the study groups , with the exception of a slightly worse disease-specific quality of life in the foam group than in the surgery group . All treatments had similar clinical efficacy , but complications were less frequent after laser treatment and ablation rates were lower after foam treatment . ( Funded by the Health Technology Assessment Programme of the National Institute for Health Research ; Current Controlled Trials number , IS RCT N51995477 . ) Since thrombotic complications , such as superficial thrombophlebitis and subsequent skin pigmentation , are common after sclerotherapy , we conducted a study to evaluate whether combining sclerotherapy with ligation of varicose veins minimizes complications and what timing for sclerotherapy would be most beneficial-accompanying surgery or several weeks postsurgery . Surgical intervention and compression sclerotherapy were performed consecutively on 111 limbs ( group A ) , and sclerotherapy was performed 28 days after surgical intervention on 87 limbs ( group B ) . The volume of sclerosant used and the frequency of complications ( thrombus formation and pigmentation ) were analyzed . Plasma levels of thrombin-antithrombin III complex ( TAT ) and D-dimer ( DD ) , as markers for activation of coagulation , were compared . In group A , the total volume of sclerosant used in patients with complications was significantly higher than that in patients without complications . The frequency of thrombus formation and of pigmentation was significantly lower ( p < 0.01 ) in group B ( 10 % and 18 % , respectively ) than in group A ( 21 % and 37 % , respectively ) . The plasma levels of TAT 7 days after treatment were significantly lower in group B ( 3.4 + /- 1.2 mg/L ) than in group A ( 4.9 + /- 1.1 mg/L ) . Performing compression sclerotherapy 28 days after surgical intervention is effective for reducing complications and a good alternative for patients with an underlying hypercoagulable state Background Minimally invasive endothermal techniques , for example , radiofrequency ablation ( RFA ) , have revolutionized the treatment of insufficient truncal veins and are associated with an excellent outcome . The use of thermal energy requires the instillation of tumescent anesthesia around the vein . Mechanochemical endovenous ablation ( MOCA ™ ) combines mechanical endothelial damage , using a rotating wire , with simultaneous infusion of a liquid sclerosans . Tumescent anesthesia is not required as no heat is used . Prospect i ve studies using MOCA ™ in both great and small saphenous veins showed good anatomical and clinical results with fast postoperative recovery . Methods / Design The MESSI trial ( Mechanochemical Endovenous ablation versus radiofrequency ablation in the treatment of primary Small Saphenous vein Insufficiency ) is a multicenter r and omized controlled trial in which a total of 160 patients will be r and omized ( 1:1 ) to MOCA ™ or RFA .  Consecutive patients with primary small saphenous vein incompetence , who meet the eligibility criteria , will be invited to participate in this trial . The primary endpoint is anatomic success , defined as occlusion of the treated veins objectified with duplex ultrasonography at 1 year follow-up . Secondary endpoints are post-procedural pain , initial technical success , clinical success , complications and the duration of the procedure . Initial technical success is defined as the ability to position the device adequately , treat the veins as planned and occlude the treated vein directly after the procedure has been proven by duplex ultrasonography . Clinical success is defined as an objective improvement of clinical outcome after treatment , measured with the Venous Clinical Severity Score ( VCSS ) . Power analyses are conducted for anatomical success and post-procedural pain . Both groups will be evaluated on an intention-to-treat principle . Discussion The hypothesis of the MESSI trial is that the anatomic success rate of MOCA ™ is not inferior to RFA . The second hypothesis is that post-procedural pain is significantly less after MOCA compared to RFA.Trial registration Trial registration : NTR4613 Date of trial registration : 28 May 2014 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 To compare the long-term value of different forms of treatment for primary varicose veins with saphenous vein insufficiency . EXPERIMENTAL DESIGN A prospect i ve , partially r and omized study with 5-year follow-up . SETTING Ambulatory day-case care . PATIENTS AND INTERVENTIONS The study includes 211 patients ( 214 lower limbs ) , who received compression sclerotherapy ( CST ; n = 78 ) , radical operation ( OP ; n = 74 ) or CST combined with high tie under local anesthesia ( HT + CST ; n = 63 ) . MEASURES The patient 's subjective opinion , objective finding by the surgeon and functional ( foot-volumetric ) assessment were obtained just after treatment and 6 months , 1 , 3 and 5 years later . RESULTS Subjectively the result started to deteriorate in both the CST and HT + CST groups after one year . The patient satisfaction was greatest in the OP group throughout the study period . Objective ly the CST group cure rate fell markedly after 6 months and at 5 year follow-up the failure rate reached 51 % , while the OP group still had a high rate of cured ( 60 % ) and improved ( 35 % ) patients . The HT + CST treatment seemed to hold well for three years followed by increasing failure rate with only 16 % objective ly cured after 5 years . The foot-volumetric parameters expelled volume (= calf pump function ) and refilling flow ratio (= venous reflux ) increased 51 - 79 % respectively decreased 8 - 29 % post-treatment in all groups . After 5 years these parameters had returned to pre-treatment levels in the CST and HT + CST groups , while the OP group was still significantly improved . CONCLUSIONS Radical surgery is superior to compression sclerotherapy alone or in combination with high tie in the treatment of varicose veins with saphenous vein incompetence . The foot-volumetric assessment correlated well with and supported objective findings as a whole but could not replace the clinical examination of each individual patient BACKGROUND To compare polidocanol foam sclerotherapy with surgical treatment of patients with primary chronic venous insufficiency and active ulcer treated at a single vascular center . METHODS Fifty-eight limbs of 56 patients with active ulcers were prospect ively r and omized to undergo either surgical treatment or foam sclerotherapy . Patients completed the Aberdeen Varicose Veins Question naire ( AVVQ ) , the Venous Clinical Severity Score ( VCSS ) , and Venous Disability Score ( VDS ) . The follow-up was 502 ± 220 days . RESULTS The ulcer healed in 100 % and 91.3 % of patients treated with surgery or foam sclerotherapy , respectively ( P > 0.05 ) . There were no significant differences in AVVQ , VCSS , and VDS between the 2 groups after the procedures ( P = 0.45 , 0.58 , and 0.66 , respectively ; Mann-Whitney U test ) . Complications occurred in 14.2 % and 13.0 % in the surgical and foam sclerotherapy groups , respectively . CONCLUSIONS Surgical treatment and foam sclerotherapy  achieved high rates of ulcer healing , without a statistically significant difference . Both treatments led to significant improvements in VCSS , VDS , AVVQ scores , demonstrating improvements in clinical outcomes and quality of life BACKGROUND The long-term results of a prospect i ve , r and omized controlled trial in patients with primary varicose veins are reported . METHODS Saphenofemoral ligation ( SFL ) was done in 73 patients ( 82 legs ) . In addition , 43 ( 23 women ; age , 47 ) underwent stripping and multiple phlebectomies under general anesthesia ( group S ) , and 39 ( 32 women ; age , 49 ) had concurrent sclerotherapy under local anesthesia ( group F ) . Assessment s included CEAP C status , Venous Clinical Severity Score ( VCSS ) , Venous Segmental Disease Score ( VSDS ) , Aberdeen Varicose Vein Question naire ( AVVQ ) , and 36-Item Short-Form ( SF-36 ) scores . RESULTS CEAP C was similar between groups ( C(2 - 6 ) ) . In group S , 40 % of legs required 25 additional foam sessions ( mean volume , 11 mL ) . In group F , 47.5 % of legs required 
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Moderate- to low- quality evidence exists to suggest that recanalisation or persistence of reflux at six weeks and recurrence of reflux at one year are less frequent when EVLA is performed , compared with conventional surgery .
For the UGFS versus conventional surgery comparison , the quality of evidence is assessed to be low ; consequently , the effectiveness of  UGFS  compared with conventional surgery in the treatment of SSV varices is uncertain .