Rates of recurrence between surgery and EVLA had conflicting data, with Paravastu et al [25] noting improved recurrence rates with EVLA at 6 weeks and 1 year and Pan et al [24] noting no significant difference. Lower Extremity Chronic Venous Disease Gohel et al [48] compared timing of EVLA, either immediately (within 2 weeks) or deferred (after 6 months or resolution of ulcer) and determined that early EVLA resulted in faster healing of venous ulcers and more ulcer-free time. Current data on RFA versus EVLA is rather limited, although there have been some recent developments. Gale et al [29] randomized 48 patients into EVLA and 46 patients into RFA, with 11 RFA patients demonstrating recurrence compared with 2 cases of recurrence in the EVLA arm. A meta-analysis showed not only no statistically significant difference in long-term outcomes between conventional surgery and endovenous therapy but also no statistically significant difference in long-term outcomes between RFA and EVLA or conventional surgery [30]. An additional meta-analysis including 792 EVLA-treated and 785 RFA-treated patients demonstrated the same safety and efficacy between the 2 treatment cohorts. Outcomes included 3-day and 10-day pain scores, 1-month and 1-year QoL, occlusion, thrombophlebitis, hematoma, and recanalization. Although limited, data from this meta-analysis suggest RFA seems to have a lower overall risk of complication compared to EVLA [31]. Compression Sclerotherapy Compression sclerotherapy has been used effectively in the treatment of varicose veins, reticular veins, and telangiectasias [7,14]. In foam sclerotherapy, a liquid or foamed sclerosing drug is injected into the lumen of the varicose vein. This sclerosant is a chemical that damages the vessel wall and occludes the affecting vasculature secondary to fibrotic transformation of the vessel. Foamed sclerosant is used to increase the surface area by which the luminal wall can be treated.
Lower Extremity Chronic Venous Disease. Rates of recurrence between surgery and EVLA had conflicting data, with Paravastu et al [25] noting improved recurrence rates with EVLA at 6 weeks and 1 year and Pan et al [24] noting no significant difference. Lower Extremity Chronic Venous Disease Gohel et al [48] compared timing of EVLA, either immediately (within 2 weeks) or deferred (after 6 months or resolution of ulcer) and determined that early EVLA resulted in faster healing of venous ulcers and more ulcer-free time. Current data on RFA versus EVLA is rather limited, although there have been some recent developments. Gale et al [29] randomized 48 patients into EVLA and 46 patients into RFA, with 11 RFA patients demonstrating recurrence compared with 2 cases of recurrence in the EVLA arm. A meta-analysis showed not only no statistically significant difference in long-term outcomes between conventional surgery and endovenous therapy but also no statistically significant difference in long-term outcomes between RFA and EVLA or conventional surgery [30]. An additional meta-analysis including 792 EVLA-treated and 785 RFA-treated patients demonstrated the same safety and efficacy between the 2 treatment cohorts. Outcomes included 3-day and 10-day pain scores, 1-month and 1-year QoL, occlusion, thrombophlebitis, hematoma, and recanalization. Although limited, data from this meta-analysis suggest RFA seems to have a lower overall risk of complication compared to EVLA [31]. Compression Sclerotherapy Compression sclerotherapy has been used effectively in the treatment of varicose veins, reticular veins, and telangiectasias [7,14]. In foam sclerotherapy, a liquid or foamed sclerosing drug is injected into the lumen of the varicose vein. This sclerosant is a chemical that damages the vessel wall and occludes the affecting vasculature secondary to fibrotic transformation of the vessel. Foamed sclerosant is used to increase the surface area by which the luminal wall can be treated.