--- title: Three varicose vein treatments, followed for fourteen years. Recurrence differed twelvefold and quality of life did not differ at all publication: Medical Insights Korea section: news category: Varicose Veins canonical_url: https://medicalinsightskorea.com/news/varicose-vein-treatments-fourteen-year-outcomes author: David Seo published: 2026-10-11T09:00:00+09:00 modified: 2026-10-11T09:00:00+09:00 content_type: reporting license: Quotation permitted with attribution to Medical Insights Korea and a link to the canonical URL. --- # Three varicose vein treatments, followed for fourteen years. Recurrence differed twelvefold and quality of life did not differ at all Foam sclerotherapy sent 56.4 percent of patients back for another procedure against 8.2 percent after laser. At fourteen years all three groups reported the same symptom scores — which makes the question what you are willing to count as a cost. ## Answer In a randomised trial that followed patients with great saphenous vein reflux for fourteen years, ultrasound-guided foam sclerotherapy produced recurrent reflux in 30.8 percent of patients against 2.6 percent after high ligation and stripping and 6.1 percent after endovenous laser ablation, and re-intervention in 56.4 percent against 13.2 percent and 8.2 percent respectively — yet Aberdeen Varicose Vein Questionnaire scores at fourteen years were statistically indistinguishable across all three groups (overall P = .21). ## Key takeaways - 233 patients with symptomatic great saphenous vein reflux were randomised one-to-one-to-one to high ligation and stripping, endovenous laser ablation, or ultrasound-guided foam sclerotherapy; 214 were included in the fourteen-year analysis. - Recurrent above-knee reflux occurred in 30.8 percent after foam sclerotherapy (12 of 39), 6.1 percent after laser ablation (3 of 49) and 2.6 percent after stripping (1 of 38). - Re-intervention on the great saphenous vein was required in 56.4 percent after foam sclerotherapy, 13.2 percent after stripping and 8.2 percent after laser ablation. - Foam sclerotherapy carried a risk ratio for recurrent reflux of 11.7 against stripping and 5.0 against laser ablation. - Stripping and laser ablation performed comparably to each other on both recurrence and re-intervention. - Neovascularisation rates did not differ between treatments — 29.0, 22.5 and 23.1 percent for stripping, laser and foam respectively (P = .76). - Quality of life at fourteen years, measured by the Aberdeen Varicose Vein Questionnaire, was comparable across all three groups (overall P = .21). ## Full article Almost every comparison of varicose vein treatments reports outcomes at one, two or five years. Veins recur over decades, so those horizons answer a question nobody asked. A Finnish randomised trial went back to its patients after fourteen. ### The trial Published in the European Journal of Vascular and Endovascular Surgery, the trial randomised 233 patients with symptomatic great saphenous vein reflux equally to three treatments: high ligation and stripping, the traditional operation; endovenous laser ablation, the catheter technique; and ultrasound-guided foam sclerotherapy, in which a foamed drug is injected to close the vein. 196 patients treated at Helsinki University Hospital were invited back at fourteen years, and 214 were included in the analysis. **Fourteen-year outcomes by treatment** | | Stripping | Laser ablation | Foam sclerotherapy | | --- | --- | --- | --- | | Recurrent above-knee reflux | 2.6% (1 of 38) | 6.1% (3 of 49) | 30.8% (12 of 39) | | Re-intervention on the vein | 13.2% | 8.2% | 56.4% | | Neovascularisation | 29.0% | 22.5% | 23.1% | Foam sclerotherapy carried a risk ratio for recurrent reflux of 11.7 against stripping and 5.0 against laser ablation. For re-intervention the ratios were 4.3 and 6.9. Stripping and laser ablation were comparable to each other throughout. **56.4% vs 8.2%** — patients needing another procedure on the great saphenous vein within fourteen years, after foam sclerotherapy versus laser ablation _Source: Rahman T et al., European Journal of Vascular and Endovascular Surgery, 2026_ ### The result that complicates all of it Set against those numbers, the quality-of-life finding is the one that makes this trial worth reading rather than summarising. Aberdeen Varicose Vein Questionnaire scores at fourteen years were 8.9 after stripping, 6.1 after laser and 8.8 after foam, with an overall P of .21. Statistically, the three groups ended up in the same place. > **How both findings can be true** > Re-intervention is a treatment, and a treated recurrence stops being a symptom. More than half the foam group came back, had another procedure, and arrived at fourteen years feeling much as the other groups did. So the trial is not measuring whether foam works — it is measuring what foam costs to make work. Whether that changes the decision depends entirely on whether a patient counts repeat procedures, repeat scans and repeat appointments as a burden or as an acceptable price for avoiding an operation. That is a values question, and the trial supplies the numbers rather than the answer. The neovascularisation figures cut the same way. New vessel growth near the treated site was expected to be the weakness of open surgery, because dissection at the groin is the usual explanation for it. All three treatments produced it at similar rates — 29.0, 22.5 and 23.1 percent, with a P of .76 — which removes one of the standard arguments against stripping and suggests the mechanism is less about surgical technique than has been assumed. ### What this means where Korean practice is heading Korean national data show open surgery falling from 32,384 procedures in 2010 to 21,792 in 2020, while endovenous thermal ablation rose from 290 in 2011 to 12,126 in 2020. The shift is towards the catheter, and this trial gives that shift fourteen-year support: laser ablation matched stripping on recurrence, on re-intervention and on quality of life, without the operation. The finding it does not support is a shift towards foam as a substitute for either. Foam sclerotherapy is quicker, cheaper and least invasive, and at fourteen years it required another procedure in more than half of patients. ### What the trial cannot settle The numbers are small in absolute terms — one recurrence in the stripping arm, three in the laser arm — and a risk ratio of 11.7 with a confidence interval running from 1.6 to 85.6 reflects exactly that. The direction is firm; the magnitude is not. The trial also tested foam sclerotherapy as it was performed when the trial began, more than fourteen years ago, on the main trunk vein. Techniques, foam preparation and case selection have all moved since, and foam is now more often used on tributaries alongside an ablation than as the primary treatment of the great saphenous vein. This is evidence about a strategy, not a verdict on a drug. And it is a single-centre European trial. Nothing in it is specific to Korean patients, Korean vein anatomy or Korean practice — its value is that almost nothing else in this field has been followed this long. ## Sources - Rahman T, Noronen K, Vähäaho S, Halmesmäki K, Venermo M. Fourteen year outcomes of a randomised controlled trial comparing endovenous laser ablation, high ligation and stripping, and ultrasound guided foam sclerotherapy for great saphenous varicose veins. European Journal of Vascular and Endovascular Surgery 2026;72(3):533-540. doi:10.1016/j.ejvs.2026.01.056. PMID:41633433. https://doi.org/10.1016/j.ejvs.2026.01.056 - Shon S, Kim H, Kim HC, Cho S, Lee SH, Joh JH. National trend of the treatment for chronic venous diseases in Korea between 2010 and 2020. Annals of Surgical Treatment and Research 2023;104(1):27-33. doi:10.4174/astr.2023.104.1.27. PMID:36685771. https://doi.org/10.4174/astr.2023.104.1.27 ## Citation David Seo (2026). "Three varicose vein treatments, followed for fourteen years. Recurrence differed twelvefold and quality of life did not differ at all". Medical Insights Korea. https://medicalinsightskorea.com/news/varicose-vein-treatments-fourteen-year-outcomes Retrieved from https://medicalinsightskorea.com/news/varicose-vein-treatments-fourteen-year-outcomes