A systematic review and meta-analysis of the treatments of varicose veins

M. Hassan Murad, Fernando Coto-Yglesias, Magaly Zumaeta-Garcia, Mohamed B. Elamin, Murali K. Duggirala, Patricia J. Erwin, Victor M. Montori, Peter Gloviczki

Research output: Contribution to journalReview articlepeer-review

109 Scopus citations


Objectives: Several treatment options exist for varicose veins. In this review we summarize the available evidence derived from comparative studies about the relative safety and efficacy of these treatments. Methods: We searched MEDLINE, Embase, Current Contents, Cochrane Central Register of Controlled Trials (CENTRAL) expert files, and the reference section of included articles. Eligible studies compared two or more of the available treatments (surgery, liquid or foam sclerotherapy, laser, radiofrequency ablations, or conservative therapy with compression stockings). Two independent reviewers determined study eligibility and extracted descriptive, methodologic, and outcome data. We used random-effects meta-analysis to pool relative risks (RR) and 95% confidence intervals (CI) across studies. Results: We found 39 eligible studies (30 were randomized trials) enrolling 8285 participants. Surgery was associated with a nonsignificant reduction in the risk of varicose vein recurrence compared with liquid sclerotherapy (RR, 0.56; 95% CI, 0.29-1.06) and all endoluminal interventions (RR, 0.63; 95% CI, 0.37-1.07). Studies of laser and radiofrequency ablation and foam sclerotherapy demonstrated short-term effectiveness and safety. The quality of evidence presented in this review was limited by imprecision (small number of events), short-term follow-up, and indirectness (use of surrogate outcomes). Conclusion: Low-quality evidence supports long-term safety and efficacy of surgery for the treatment of varicose veins. Short-term studies support the efficacy of less invasive treatments, which are associated with less periprocedural disability and pain.

Original languageEnglish (US)
Pages (from-to)49S-65S
JournalJournal of vascular surgery
Issue number5 SUPPL.
StatePublished - May 2011

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine


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