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What Does the CLASS Trial Tell Us About the Way We Treat Varicose Veins In the United States?

This week’s New England Journal of Medicine reported the results of a randomized trial comparing the three most commonly performed treatments for varicose veins and saphenous venous insufficiency in the United Kingdom:  Laser ablation, surgery, and foam sclerotherapy as performed by experienced vein specialist.  Patients that were treated surgically had proximal ligation and stripping of the saphenous veins and phlebectomy of the associated varicosities. The foam sclerotherapy treatment consisted of foam sclerotherapy of the saphenous veins and foam sclerotherapy of varicose veins. The laser ablation treatment had laser ablation of the saphenous vein followed by foam sclerotherapy of the varicose veins (Brittenden, et al., 2014).

All treatments improved general quality of life measure and had similar clinical efficacy; however, the foam sclerotherapy treatment from both the saphenous and varicose veins had the lowest improvement of disease specific quality of life compared to the other two treatments.  The foam sclerotherapy for the saphenous vein also had the lower rate of successful ablation of the saphenous vein compared to the surgical treatment of the saphenous vein.  The laser treatment of the saphenous vein followed by foam sclerotherapy of varicose veins had lowest rate of procedural complication rate (Brittenden, et al., 2014). Thus this study showed that while all treatments were effective, laser ablation of the saphenous vein followed by foam sclerotherapy of the varicose veins is the best treatment combination for varicose veins with saphenous insufficiency.

How does this relate to treatment of varicose veins in the United States? Foam sclerotherapy to close saphenous veins is not a treatment commonly performed in the United States. The most common method of treatment in the United States is the laser ablation of the saphenous veins followed by foam sclerotherapy of the associated varicose veins, which in this study had the best results. Surgical stripping of saphenous veins and phlebectomies of varicose veins are less frequently performed because they have a longer recovery time and higher complication rate.   This study validates the preferred and most common method of treatment in the United States is shown to be the most effective in terms of low procedure complication rates and best improvement in disease specific quality of life. The one unfortunate twist is that in the United States, insurance companies sometimes do not cover the treatments shown by well-designed randomized controlled comparison studies such as these, instead the companies choose to cover the treatments recommended their employed medical directors.

 

References

Brittenden, J., Cotton, S., Elders, A., Ramsay, C., Norrie, J., Burr, J., . . . Wileman, S. (2014). A Randomized Trial Comparining Treatments for Varicose Veins. The New England Journal of Medicine, 1218-1223.

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Dr. Wright is a Diplomate of the American Board of Venous and Lymphatic Medicine. He is an active member of numerous professional organizations, including the American College of Phlebotomy, American Society for Laser Medicine and Surgery, Missouri State Medical Association, American Academy of Cosmetic Surgery, American Registry for Diagnostic Medical Sonography, and the AMA.

Dr. Wright is the medical director at Laser Lipo and Vein Center with locations in St. Louis and O’Fallon, MO.  For more information, contact his practice at www.laserlipoandviens.com or (636) 614-1665.

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