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Is there a continuing role for traditional surgery?

Patrick A Coughlin1, David C Berridge2

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Traditional open surgery remains crucial for varicose veins management, offering comparable long-term outcomes to endovenous methods. Further research is needed to fully evaluate newer techniques against established surgical approaches.

Keywords:
Endovenous ablationvaricose vein surgery

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Area of Science:

  • Vascular Surgery
  • Phlebology
  • Minimally Invasive Procedures

Background:

  • Recent guidance favors endovenous treatments for varicose veins, but evidence quality and long-term data are debated.
  • Open surgery has historical long-term recurrence data, predating modern diagnostic and assessment standards.
  • Endovenous techniques (UGFS, EVLT, RFA) are considered as effective as surgery for great saphenous vein (GSV) reflux in meta-analyses.

Purpose of the Study:

  • To evaluate the continued role of traditional open surgery in varicose vein management.
  • To compare the long-term efficacy and cost-effectiveness of open surgery versus endovenous techniques.
  • To address limitations in current evidence regarding endovenous treatment outcomes and patient selection.

Main Methods:

  • Review of existing meta-analyses and randomized controlled trials comparing open surgery with endovenous ablation.
  • Analysis of data from studies like the CLASS trial and Carradice's research on patient eligibility and outcomes.
  • Consideration of factors influencing treatment choice, including anatomical features and reflux type (e.g., SSV vs. LSV).

Main Results:

  • Meta-analyses show non-significant differences in recurrence risk between open surgery and endovenous therapies.
  • Some endovenous techniques (UGFS) show poorer results for LSV reflux.
  • Patient selection for trials is often restrictive, limiting generalizability of findings.

Conclusions:

  • Open surgical techniques remain essential for varicose vein management, particularly for LSV reflux, offering reliable short and long-term outcomes.
  • Endovenous techniques are increasingly first-line for SSV reflux, but device limitations and anatomical factors necessitate continued use of open surgery.
  • Open surgery provides a cost-effective option with established efficacy, especially when compared to endovenous methods with less long-term data.