Review of randomized controlled trials comparing endovenous thermal and chemical ablation

In the past decade, the development of minimally invasive correction of primary venous reflux of the great saphenous vein (GSV) by endovenous techniques has provided a patient-friendly means to treat this disorder as an office- based procedure with ablation of the GSV using radiofrequency (RFA), laser (EVLA), or sclerotherapy. What do the randomized controlled trials (RCT) teach us about these new endovenous procedures? There are 7 RCT's (493 patients) in 9 papers comparing RFA with open surgery (OS); 12 RCT's (2327 patients) in 16 papers comparing EVLA with OS; 5 RCT's (570 patients) comparing RFA with EVLA; 6 RCT's (699 patients) with modifications of EVLA; 2 RCT's (153 patients) in 3 papers comparing EVLA with cryostripping; 6 RCT's (1406 patients) in 7 papers comparing foam sclerotherapy with OS; 2 RCT's (166 patients) comparing EVLA with foam sclerotherapy; 1 RCT (580 patients) in 2 papers comparing RFA versus EVLA versus foam sclerotherapy versus OS.ConclusionBased on the presented RCT's with caveats mentioned in the paper, the differences between modern open surgery and the new endovenous procedures are insignificant and no treatment modality can be recommended as superior to another. Nevertheless it is established that chemical ablation is the cheapest, but redo-treatment is more frequent related to recurrence.