Individual research recommendation details

Recommendation ID

CG168/4

Question

Truncal treatment with or without concurrent tributary treatment:- What is the clinical and cost effectiveness of concurrent phlebectomies or foam sclerotherapy for varicose tributaries during truncal endothermal ablation for varicose veins compared with:
- truncal endothermal ablation without concurrent phlebectomies or foam sclerotherapy?
- truncal endothermal ablation with phlebectomies or foam sclerotherapy, if needed, 6–12 weeks later?

Any explanatory notes
(if applicable)

Why this is important:- Conventional truncal stripping under general anaesthetic involves synchronous phlebectomies of varicose tributaries, and in ultrasound-guided foam sclerotherapy truncal and tributary veins are treated concurrently. In contrast, endothermal ablation may be performed alone to obliterate truncal incompetence, or synchronously with phlebectomies or foam sclerotherapy and current practice varies.
Synchronous tributary treatment ensures a single treatment episode, and the removal of all symptomatic varicosities leads to a better immediate quality of life, but this takes longer and thus may be associated with increased morbidity. Deferred tributary treatment may reduce morbidity, and also mean that some patients do not need tributary treatment (or need fewer tributary treatments on smaller veins). However, it involves 2 interventions for patients who need tributary treatment. Omitting tributary treatments entirely ensures a single treatment episode, but it is unclear whether remaining varicosities will persist and impair quality of life.
At present there is limited evidence from 1 small-scale (n=50) study on the use and timing of tributary treatments after truncal endothermal ablation. There is a need for practice to be based on empirical evidence from a large and sufficiently powered RCT comparing all 3 main intervention options (no tributary treatment, concurrent tributary treatment and delayed tributary treatment).

Source guidance details

Comes from guidance

Varicose veins: diagnosis and management

Number

CG168

Date issued

July 2013

Other details