Surgery and endovenous techniques for the treatment of small saphenous varicose veins: a review of the literature

In 15% of all patients, varicosis is caused by insufficiency of the small saphenous vein (SSV). In the past it was common to entirely remove the SSV by surgical procedure; however, recently minimally invasive techniques have taken over a significant number of varicose vein treatments. The aim of this paper is a review of the literature of all treatment modalities of the insufficient SSV. The search aimed to identify all papers published describing one or more treatments for SSV insufficiency. International literature databases were searched through for articles eligible for this review. Articles describing one or more treatment techniques for SSV insufficiency were eligible for this review. Also studies describing SSV as well as greater saphenous vein were included as long as they made a clear distinction in their results between the two groups. Studies were excluded if they did not use ultrasound examination to qualify outcome, as this is the golden standard to evaluate venous insufficiency. Seventeen articles were included in this review. Five articles on surgical treatment showed success rates varying from 24% to 100% (follow-up 1.5-60 months). Ten articles on endovenous laser ablation (EVLA) showed success rates varying from 91% to 100% (follow-up 1.5-36 months). Two articles on ultrasound-guided foam sclerotherapy (UGFS) showed success rates varying from 82% to 100% (follow-up 1.5-11 months). Statistical analysis showed a significant difference (P <0.05) in success rate of 47.8% versus 94.9% for surgery and EVLA/UGFS, respectively. Most complications for all treatment techniques were mild and self-limiting. Rates of deep venous thrombosis were not described often and in the articles that mentioned it, varied from 1.8% to 3.5% (surgery) and 2.5-5.7% for EVLA. In the absence of large, comparative randomized clinical trials, minimally invasive techniques appear to have a tendency towards better results than surgery, in the treatment of the insufficient SSV.