***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 OBJECTIVE The objective of this study was to assess the differences in clinical outcomes in patients treated with endovenous saphenous vein obliteration with technical outcome of either complete occlusion ( CO ) , near complete occlusion ( NCO ) , defined as < or = 5-cm segment of flow in treated vein , or recanalization , defined as > 5-cm segment of flow in treated vein . STUDY DESIGN The study was design ed as a prospect i ve registry with follow-up at intervals through 24 months . The subjects were 286 patients from 30 clinical sites with saphenous vein reflux as measured with duplex scanning . A total of 319 limb treatments were performed . Intervention included endovenous catheter obliteration of insufficient saphenous veins with temperature controlled radiofrequency heat , without high ligation of the saphenofemoral junction . The main outcome measures were status of occlusion of treated vein segments , presence of varicose veins and reflux , clinical symptoms scores , physician evaluation of procedure success , and patient satisfaction . RESULTS At 12 months , 83.6 % of treated limbs were classified as CO , 5.6 % were categorized as NCO , and 10.8 % were recanalized . At 24 months , 85.2 % of treated veins were CO , 3.5 % were NCO , and 11.3 % were recanalized . Varicose veins were present in 95 % of limbs before treatment . The presence of varicose veins in limbs with CO was 10.5 % , 7.3 % , 5.7 % , and 8.3 % at 1 week , 6 months , 12 months , and 24 months , respectively . The presence of varicose veins in NCO limbs was similar at each interval . Overall , 91.4 % of 232 limbs followed to 12 months and 90.1 % of 142 limbs at 24 months were free of saphenous vein reflux , regardless of technical outcome . Paresthesia was reported in 3.9 % of limbs at 1 year and in 5.6 % at 2 years . The pretreatment mean symptom severity score was 2.0 . Mean posttreatment symptom scores decreased to 0.07 , 0.0 , and 0.50 for CO , NCO , and recanalized limbs , respectively , at 6 months . At 12 months , the mean scores were 0.06 , 0.0 , and 0.32 for CO , NCO , and recanalized limbs , respectively ; at 24 months , the scores were at 0.10 , 0.40 , and 0.63 . Patient satisfaction was achieved in 195 of 212 patients ( 92 % ) at 1 year and in 121 of 128 ( 94.5 % ) at 2 years . CONCLUSION Endovenous vein obliteration without high ligation dramatically reduces the presence of varicosities and reflux and , when performed with the prescribed pull-back methodology , is comparable with vein stripping at 1 and 2 years . Patient satisfaction with the procedure is high at 2 years , regardless of technical outcome . At 2 years , the closure procedure is a viable alternative to stripping Abstract Objectives Venous disease was proposed as a cause of restless legs syndrome ( RLS ) by Dr Karl A Ekbom in 1944 , but has since remained largely unexplored . This study examines the effect of endovenous laser ablation ( ELA ) in patients with concurrent RLS and duplex-proven superficial venous insufficiency ( SVI ) . Methods Thirty-five patients with moderate to very severe RLS ( as defined by the 2003 National Institute of Health ( NIH ) RLS criteria ) and duplex-proven SVI completed an international RLS rating scale question naire ( IRLS ) and underwent st and ard duplex examination to objective ly measure the baseline severity of their conditions . They were separated into non-operative and operative cohorts . The operative cohort underwent ELA of refluxing superficial axial veins using the CoolTouch CTEV 1320 nm laser and ultrasound-guided sclerotherapy of the associated varicose veins with foamed sodium tetradecyl sulphate ( STS ) . All patients then completed a follow-up IRLS question naire . Baseline and follow-up IRLS scores were compared . Results Operative correction of the SVI decreased the mean IRLS score by 21.4 points from 26.9 to 5.5 , corresponding to an average of 80 % improvement in symptoms . A total of 89 % of patients enjoyed a decrease in their score of ≥15 points . Fifty-three percent of patients had a follow-up score of ≤5 , indicating their symptoms had been largely alleviated and 31 % had a follow-up score of zero , indicating a complete relief of RLS symptoms . Conclusions ELA of refluxing axial veins with the CTEV 1320 nm laser and foamed STS sclerotherapy of associated varicosities alleviates RLS symptoms in patients with SVI and moderate to very severe RLS . Recommendations SVI should be ruled-out in all patients with RLS before initiation or continuation of drug therapy 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 OBJECTIVE To compare the clinical efficacy and safety of endovenous laser treatment ( EVLT ) with high ligation and stripping ( HLS ) as st and ard treatment for great saphenous vein ( GSV ) insufficiency . DESIGN Two-center r and omized controlled trial with 2-year follow-up . SETTING Interventions were performed on ambulatory and hospitalized patients at 2 vein centers , a university dermatology department ( EVLT-treated group ) , and a specialized vein clinic ( HLS-treated group ) . PATIENTS R and om sample of 400 patients with GSV insufficiency . INTERVENTIONS Patients were assigned ( 1:1 ) to EVLT or HLS of the GSV from September 2004 through March 2007 ; 185 and 161 patients ( limbs ) , respectively , were treated per protocol . MAIN OUTCOME MEASURES Clinical ly recurrent varicose veins after surgery ( REVAS classification , primary study objective ) , duplex-detected saphenofemoral recurrence , clinical venous severity scoring ( Homburg Varicose Vein Severity Score ) , hemodynamics ( venous refilling time ) , quality of life ( Chronic Venous Insufficiency Question naire 2 ) , adverse effects , and visual analog scale-based evaluations of patients ' satisfaction . RESULTS Clinical ly recurrent varicose veins after surgery were similarly observed in both groups : 16.2 % ( EVLT-treated group ) vs 23.1 % ( HLS-treated group ) ; P = .15 . Duplex-detected saphenofemoral refluxes occurred significantly more frequently after EVLT ( 17.8 % vs 1.3 % ; P < .001 ) . Both treatments equally improved medical condition ( Homburg Varicose Vein Severity Score ) and disease-related quality of life . Endovenous laser treatment caused more adverse effects ( phlebitic reaction , tightness , dyspigmentation ) but revealed advantages concerning 
    Output:
    
There were also no differences between the treatment groups for recanalisation ( early or late ) ( OR 0.68 , 95 % CI 0.01 to 81.18 ; P = 0.87 and OR 1.09 , 95 % CI 0.39 to 3.04 ; P = 0.87 , respectively ) , neovascularisation ( OR 0.31 , 95 % CI 0.06 to 1.65 ; P = 0.17 ) or technical failure ( OR 0.82 , 95 % CI 0.07 to 10.10 ; P = 0.88).QoL scores , operative complications and pain were not amenable to meta- analysis , however quality of life generally increased similarly in all treatment groups and complications were generally low , especially major complications .
Pain reporting varied greatly between the studies but in general pain was similar between the treatment groups .
Currently available clinical trial evidence suggests that UGFS , EVLT and RFA are at least as effective as surgery in the treatment of great saphenous varicose veins .