***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: PURPOSE Surgical treatment of varicose veins with preservation of the greater saphenous vein ( GSV ) was studied . METHODS Patients with reflux at the saphenofemoral junction and grossly normal GSV were treated with two different surgical techniques : perivalvular b and ing valvuloplasty ( PVBV-A ) of the saphenous valve , wherein the diameter of the uppermost saphenous valve was narrowed by Dacron-reinforced silicone b and ( 12 patients , 15 extremities ) ; and high ligation ( HL-A ) of the saphenous vein , wherein the GSV was ligated flush with the femoral vein ( 14 patients , 16 extremities ) . Both groups also had varicose tributaries of GSV avulsed through multiple stab incisions . RESULTS In the HL-A group two GSV ( 13 % ) remained completely patent , 10 GSV ( 62.5 % ) thrombosed partially , and the remaining four GSV ( 25 % ) had complete thrombosis . In the PVBV-A group 12 GSV ( 80 % ) remained completely patent and without reflux , one GSV ( 7 % ) remained patent but showing reflux . Two GSV ( 13 % ) thrombosed completely . There were no surgical complications or recurrences ( mean follow-up was 9.4 months for PVBV-A and 9.5 months for HL-A ) , and the postoperative recovery time was similar for both groups . CONCLUSIONS Both techniques are equally effective in the early elimination of varicosities . Preservation of the saphenous vein is significantly better after PVBV-A ( p < 0.01 ) . A prospect i ve r and omized trial with long-term follow-up is required 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 The influence of compression sclerotherapy upon hemostasis activation was investigated in 41 consecutive patients with lower extremity varices by serial measurement of thrombin-antithrombin III complexes ( TAT ) , D-dimer , fibrinogen and C-reactive protein ( CRP ) . Blood sampling was carried out before operation and on the 7th and 28th post-operative day in patients r and omly assigned to either the  control group ( n = 18 ) , in which high ligation of sapheno-femoral junction and local excision of varices were performed , or the  sclerotherapy group ( n = 23 ) in which the comparable surgical intervention and compression sclerotherapy using hypertonic saline were performed simultaneously . In both groups , the TAT , D-dimer and fibrinogen concentrations at day 7 were significantly elevated compared to the value before operation while CRP showed no significant change during the observation period . In the sclerotherapy group , higher incidence of superficial thrombosis was observed and the TAT concentration at day 7 was significantly higher than that in the control group ( p < 0.01 ) , and the TAT at day 28 was still significantly elevated compared to the pre-operative level ( p < 0.05 ) . However , no relationship between TAT and D-dimer concentrations and the extent of superficial thrombosis was observed . We conclude that compression sclerotherapy for lower extremity varices causes latent activation of coagulation system and can be a risk factor for venous thromboembolism A prospect i ve observational study of 63 legs in 49 patients was undertaken to evaluate the adequacy of  primary varicose vein surgery  performed by surgical trainees . Appropriate surgery was carried out by a surgical senior house officer ( SHO ) under direct consultant supervision . All patients underwent pre- and postoperative duplex scanning .  The preoperative duplex scan demonstrated incompetence of the saphenofemoral junction ( SFJ ) or long saphenous vein ( LSV ) in 59 limbs , a mid-thigh perforator ( MTP ) in 11 limbs , and saphenopopliteal junction ( SPJ ) in 5 limbs . Surgery successfully abolished all sites of pre-existing reflux . The postoperative duplex scan revealed that 17 new sites of reflux , not identified preoperatively , had developed in 12 limbs . With a consultant-led service and accurate preoperative identification of sites of reflux , the surgical trainee can adequately perform varicose vein surgery . This would seem a reasonable approach to training and eliminating recurrence owing to inadequate surgery . The development of new sites of reflux within 6 months of varicose vein surgery may be owing to altered venous haemodynamics consequent upon this surgery 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 OBJECTIVE AND DESIGN in 1978 Sheppard described using a flap of pectineus fascia in an attempt to reduce the further development of neovascularised veins at the saphenofemoral junction . The perceived benefits of this manoeuvre have not been tested by a prospect i ve r and omised trial . MATERIAL S AND METHODS consecutive patients with symptomatic recurrent varicose veins referred to a single consultant were examined for evidence of further reflux from the saphenofemoral junction . This was subsequently confirmed in forty limbs ( thirty-seven patients ) by descending venography .  All had features of a neovascularised segment . These patients were treated by complete exposure and ligation of the recurrences arising from the common femoral vein , with or without the placement of a flap of pectineus fascia ( prospect ively r and omised ) . The patients were assessed a minimum of eighteen months later by both clinical examination and duplex ultrasound scanning . RESULTS six patients were lost to follow-up . This left seventeen limbs remaining in each half of the study . The characteristics in each group were broadly matched . CONCLUSIONS this study failed to demonstrate any apparent benefit from the application of a flap of pectineus fascia . Most patients showed evidence of re-recurrence arising from the common femoral vein In a prospect i ve study of 100 sequential varicose patients treated with sclerotherapy  , 15 had some light brown pigmentations at the end of the treatment . One year later , 1 patient still had some linear pigmentations , while 4 other patients had a single , macular , barely visible pigmentation of no cosmetic significance BACKGROUND Although no r and omized controlled trial has assessed the effects of either compression sclerotherapy or ambulatory phlebectomy , both techniques are used to treat varicose veins worldwide . We performed a r and omized controlled trial to compare recurrence rates of varicose veins and complications after compression sclerotherapy and ambulatory phlebectomy . METHODS From September 1996 to October 1998 , we r and omly allocated 49 legs to compression sclerotherapy and 49 legs to ambulatory phlebectomy .  Our primary outcome parameters were as follows : recurrence rates at 1 and 2 years and complications related to therapy . Eighty-two patients were included , of whom 16 were included with both of their legs . The number of treated legs was therefore 98 , but two patients were lost to follow-up . RESULTS One year recurrence amounted to 1 out of 48 for phlebectomy and 12 out of 48 for compression sclerotherapy ( P < 0.001 ) ; at 2 years , six additional recurrences were found , but then solely for compression sclerotherapy ( P < 0.001 ) . Significant differences in complications occurring more in phlebectomy than in compression sclerotherapy therapy were blisters , teleangiectatic matting , scar formation , and bruising from b and aging . CONCLUSION Our results show that ambulatory phlebectomy is an effective therapy for varicose veins of the leg . Recurrence rates are significantly lower than for compression sclerotherapy therapy . If varicose veins persist 4 weeks after compression sclerotherapy , it can be argued that to reduce the risk of future recurrence ambulatory phlebectomy should be considered as the better treatment option 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 
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However , the trend was for sclerotherapy to be evaluated as significantly better than surgery at one year ; after one year ( sclerotherapy result ed in worse outcomes ) the benefits with sclerotherapy were less , and by three to five years surgery had better outcomes .
REVIEW ERS ' CONCLUSIONS There was insufficient evidence to preferentially recommend the use of sclerotherapy or surgery .