• treatment realted adverse events and complications [ Time Frame: 3 months, 1 and 5 years ]
• patient reported outcomes (HRQOL and treatment satisfaction) [ Time Frame: 3 months, 1 and 5 years ]
• cost effectiveness analysis [ Time Frame: 3 months, 1 and 5 years ]

For more than 100 years, surgery has been the standard of care of varicose veins of the legs. The down side of surgery is that it requires anesthesia, leaves scars, and has a relatively high recurrence rate in the long term (up to 40%). In the last decade, several new techniques have become available but they have not yet been compared to surgery. This trail will evaluate the effectiveness, patients` perspective and cost effectiveness of surgery and non-invasive techniques such as ultrasound guided sclerocompression therapy and endovenous laser therapy.

Inclusion criteria:

• Ultrasound confirmed GSV insufficiency (reflux time >0.5 second and vein diameter ≥0.5 cm)
• non-treated GSV variocoses
• CEAP -classification > C2 and As2
• >18 years old
• Informed consent.

Exclusion criteria:

• Acute venous thrombosis / flebitis
• Agenesia of deep venous system
• Vascular syndromes
• Post-trombotic syndroom of occlusive type
• Contra-indications for surgery

Primary outcomes:

1. anatomical succes using US (absence of GSV or flow) (at 3 months, 1 and 5 year)

Secondary outcomes:

1. treatment induced adverse events and complications (after 3 months)
2. patient repiorted outcomes (HRQOL and treatment satisfaction)(after 3 monhts)
3. cost effectiveness analyses (after 1 and 5 years)

Included patients: total of 240 (80 per arm)

Study start: May 2007 (recruitment ongoing) Study completion: May 2011

Follow up after 3 months, 1, 2, 3, 4 and 5 years

Location: departmnent of dermatology, Erasmus MC, Rotterdam, The Netherlands

Principle investigators: M. Kockaert, T. Nijsten & M. Neumann

Publications:

Rasmussen LH, Bjoern L, Lawaetz M, Blemings A, Lawaetz B, Eklof B. Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: short-term results. J Vasc Surg. 2007 Aug;46(2):308-15. Epub 2007 Jun 27.

Sharif MA, Lau LL, Lee B, Hannon RJ, Soong CV. Role of endovenous laser treatment in the management of chronic venous insufficiency. Ann Vasc Surg. 2007 Sep;21(5):551-5.

Mundy L, Merlin TL, Fitridge RA, Hiller JE. Systematic review of endovenous laser treatment for varicose veins. Br J Surg. 2005 Oct;92(10):1189-94.

Jia X, Mowatt G, Burr JM, Cassar K, Cook J, Fraser C.Systematic review of foam sclerotherapy for varicose veins. Br J Surg. 2007 Aug;94(8):925-36.

Subramonia S, Lees TA.The treatment of varicose veins.Ann R Coll Surg Engl. 2007 Mar;89(2):96-100.

Bohler K. Varicose veins: disfigurement or disease? Herz. 2007 Feb;32(1):18-25.

Bamigboye AA, Smyth R. Interventions for varicose veins and leg oedema in pregnancy. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001066.

van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T. New endovenous therapies of truncal varicosities are more effective than surgical stripping and sclerotherapy: meta-analysis and meta-regression. Lancet, Submitted

• Procedure: crossectomie and short stripping
• Procedure: ultrasound guided sclerocompression therapy
• Procedure: endovenous laser therapy

• Active Comparator: Surgery: crossectomie plus short stripping
• Active Comparator: ultrasound guided sclerocompression therapy with foam (3% polidaconal)
• Active Comparator: Endovenous laser therapy (940 nm, about 70 J/cm)

Inclusion Criteria:

• primary insufficient GSV objectived with US: reflux>0.5 sec and diameter>0.5cm)
• non-treated varicose veins
• >18 years
• informed consent

Exclusion Criteria:

• acute thrombosis or flebitis
• agnesia of deep venous system
• vascular syndromes
• use of anticoagulantia
• contraindications surgery