CONTEXT AND POLICY ISSUES
Varicose veins are enlarged tortuous superficial veins at least 3mm in diameter that usually affect the great (GSV) and small (SSV) saphenous veins in the lower limbs.1,2 Varicose veins are caused by decreased elasticity of the vein wall and poorly functioning valves within the vein, resulting in blood pooling in the veins and vein enlargement.2,3 The symptoms of varicose veins can range in severity from occasional discomfort to severe ulceration of the skin.1,2 Approximately 10 to 40% of Western populations have varicose veins, and varicosities can cause considerable disability, resulting in decreased quality of life and loss of work days.1,2 If left untreated, varicose veins can progress to chronic venous insufficiency, which increases the likelihood of tissue damage and development of venous stasis ulcers.1
Surgery, including saphenous vein ligation and stripping, has been standard therapy for the treatment of varicose veins.4,5 Surgery, however, is invasive and may be associated with a greater incidence of complications and slower recovery relative to newer treatments such as endovascular thermal ablation (EVTA).6 Sclerotherapy is also a common therapy for smaller varices (< 4mm) in patients with less severe disease, but multiple treatments are often required.7,8 EVTA, which includes laser (EVLT) and radiofrequency ablation (RFA), are therapies that are less invasive than surgery, and preliminary data suggest that EVTA is associated with similar treatment success rates with reduced recovery time and complications relative to surgery.6 EVTA requires specialized equipment and training, however, and it is
unclear whether long-term clinical effectiveness, safety, and cost-effectiveness is improved with EVTA therapies relative to traditional therapies including surgery and sclerotherapy. In addition, it is unclear whether there are differences in terms of effectiveness and complications between EVLT and RFA.
The purpose of this review is to provide an update of a Rapid Response report produced by CADTH in 2011.9 It compares the available evidence for the treatment of uncomplicated varicose veins, with a focus on endovascular thermal ablation compared with surgery or Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid esponses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. \CADTH is not liable for any loss or damages resulting from use of the information in the report.
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