Injection sclerotherapy for varicose veins

Paul V Tisi; Catherine Beverley; Angie Rees

doi:10.1002/14651858.CD001732.pub2

Tratamiento con inyecciones esclerosantes para las venas varicosas

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Referencias

Referencias de los estudios incluidos en esta revisión

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Abramowitz I. The treatment of varicose veins in pregnancy by empty vein compressive sclerotherapy. South African Medical Journal 1973;47(14):607‐10.

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Hamel‐Desnos C, Desnos P, Wollmann JC, Ouvry P, Mako S, Allaert FA. Evaluation of the efficacy of polidocanol in the form of foam compared with liquid form in sclerotherapy of the greater saphenous vein: initial results. Dermatologic Surgery 2003;29(12):1170‐5.

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Referencias de los estudios excluidos de esta revisión

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Ariyoshi H, Kambayashi J, Tominaga S, Hatanaka T. The possible risk of lower‐limb sclerotherapy causing an extended hypercoagulable state. Surgery Today 1996;26(5):323‐7.

Belcaro G, Christopoulos D, Vasdekis S. Treatment of superficial venous incompetence with the SAVAS technique (Section Ambulatoire des Varices avec Sclerotherapie). A 4 year randomised, controlled trial comparing venous hemodynamic and costing after SAVAS, sclerotherapy and the dentist's technique. Journal des Maladies Vasculaires 1991;16(1):23‐7.

Belcaro G, Dugall M, Vasdekis S, Christopoulos D, Laurora G, Nicolaides AN, et al. Comparison between endovascular sclerotherapy, surgery and surgery plus sclerotherapy in the treatment of superficial vein insufficiency. A randomized study on 10 years follow‐up [Comparaison entre la sclerotherapie endovasculaire, la chirurgie et al chirurgie associee a la sclerotherapie dans le traitment de l'incontinence des veines superficielles. Une etude randomisee sur 10 ans de sum]. Angeologie 1998;50(1):57‐61.

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Belcaro G, Cesarone MR, Dugall MD, Griffin M, Di Renzo A, Ricci A. Primary classic sclerotherapy registry and trial: The Sclero Randomized 10‐year follow‐up study in chronic venous insufficiency. Abstracts from the UIP World Congress Chapter Meeting (www.phlebology.org/AbstractUIP.htm#13). San Diego, 2003. [5420]

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Chant ADB, Jones HO, Weddell JM. Varicose veins: a comparison of surgery and injection/compression sclerotherapy. Lancet 1972;2(7788):1188‐91.

Piachaud D, Weddell JM. The economics of treating varicose veins. International Journal of Epidemiology 1972;1(3):287‐94.

de Roos KP, Nieman FHM, Neumann HAM. Ambulatory phlebectomy versus compression sclerotherapy: results of a randomized controlled trial. Dermatologic Surgery 2003;29(3):221‐6.

Doran FSA, White M. A clinical trial designed to discover if the primary treatment of varicose veins should be by Fegan's method or an operation. British Journal of Surgery 1975;62(1):72‐6.

Einarsson E, Eklof B, Neglen P. Sclerotherapy or surgery as treatment for varicose veins: a prospective randomized study. Phlebology 1993;8(1):22‐6.

Neglen P, Einarsson E, Eklof B. The functional long‐term value of different types of treatment for saphenous vein incompetence. Journal of Cardiovascular Surgery 1993;34(4):295‐301.

Hobbs JT. Surgery and sclerotherapy in the treatment of varicose veins. A random trial. Archives of Surgery 1974;109(6):793‐6.

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Iwamoto S, Ikeda M, Kawasaki T, Monden M. Treatment of varicose veins: an assessment of intraoperative and postoperative compression sclerotherapyy. Annals of Vascular Surgery 2003;17(3):290‐5.

Jakobsen BH. The value of different forms of treatment for varicose veins. British Journal of Surgery 1979;66(3):182‐4.

Kanter AH. Complications of Sotradecol sclerotherapy with and without heparin. In: Raymond‐Martimbeau P, Prescott R, Zummo M editor(s). Phlebology '92. Vol. 2, Paris: John Libbey Eurotext, 1992:861‐2.

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Lupton J, Alster TS, Romero P. Clinical comparison of sclerotherapy versus long‐pulsed Nd:YAG laser treatment for lower extremity telangiectases. Dermatologic Surgery 2002;28(8):694‐7.

Raymond‐Martimbeau P, Dupuis JL. Telangiectasias: incidence, classification, and relationship with the superficial and deep venous systems: a double‐blind study. In: Negus D, Jantet G, Coleridge‐Smith PD editor(s). Phlebology '95. Vol. 1 Suppl 1, London: Springer, 1995:169‐171.

Martimbeau PR. A randomized clinical trial comparing the sclerosing and side effects of foam Vs. liquid formula for sclerotherapy of primary varicose veins. Abstracts from the UIP World Congress Chapter Meeting (www.phlebology.org/AbstractUIP.htm#144). San Diego, 2003. [5433]

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Rutgers PH, Kitslaar PJ. Randomized trial of stripping versus high ligation combined with sclerotherapy in the treatment of the incompetent great saphenous vein. American Journal of Surgery 1994;168(4):311‐5.

Sadick NS. Sclerotherapy of varicose and telangiectatic leg veins. Minimal sclerosant concentration of hypertonic saline and its relationship to vessel diameter. Journal of Dermatologic Surgery & Oncology 1991;17(1):65‐70.

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Referencias adicionales

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Referencias de otras versiones publicadas de esta revisión

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Tisi PV, Beverley CA. Injection sclerotherapy for varicose veins. Cochrane Database of Systematic Reviews 2002, Issue 1. [DOI: 10.1002/14651858.CD001732]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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estudios excluidos

Abramowitz 1973

Methods	Hospital‐based study. Duration of recruitment to study: not stated. Duration of follow‐up: 6 to 24 months. Parallel trial. Randomisation method: not stated. Blinding: patient ‐ no; doctor ‐ no; outcome assessor ‐ not stated. Cross‐overs: unknown. Risk of bias: moderate.
Participants	101 patients. Age: not stated. Sex: female. Inclusion criteria: pregnant, primary or recurrent VV. Exclusion criteria: not stated. Venous problem: varicose veins. Drop‐outs: 29 patients at study end; 1 in sclerotherapy group and 28 in compression stockings group.
Interventions	Sclerotherapy versus graduated compression stockings.
Outcomes	1. Symptomatic improvement and cosmetic result.
Notes	Sclerosant: STD. Dose: 0.5 ml (concentration not stated). Number of sites: not stated.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Batch 1980

Methods	Hospital‐based study. Duration of recruitment to study: 3 years. Duration of follow‐up: 6 years. Parallel trial. Randomisation method: not stated. Blinding: patient ‐ no; doctor ‐ no; outcome assessor ‐ yes. Cross‐overs: none. Risk of bias: moderate.
Participants	148 patients: 169 legs. Age: not stated. Sex: not stated. Inclusion criteria: primary or recurrent VV. Exclusion criteria: saphenofemoral or saphenopopliteal incompetence. Venous problem: no saphenofemoral or saphenopopliteal incompetence. Drop‐outs: 9 legs at 3 weeks; 16 at 3 months; 49 at 1 year; 116 at 2 years.
Interventions	Sclerotherapy with bandaging for 3 weeks versus 6 weeks.
Outcomes	1. Patient questionnaire: pain, mobility, cosmetic appearance, general satisfaction (3 = best score, 11 = worst). 2. Doctor assessment: phlebitis, pigmentation, induration, disappearance of varicosities (3 = best score, 11 = worst). 3. Number of patients requiring treatment for recurrent VV.
Notes	Sclerosant: not stated. Dose: not stated. Number of sites: not stated. Bandaging technique: Sorbo rubber pads, crepe, Elastoplast.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Belcaro 2003b

Methods	Multicentre hospital‐based study. Duration of recruitment to study: not stated. Duration of follow‐up: 10 years. Parallel trial. Randomisation method: random code. Blinding: patient ‐ not stated; doctor ‐ not stated; outcome assessor ‐ not stated. Cross‐overs: none. Risk of bias: low.
Participants	534 patients. Age: 25 to 65. Sex: 33% men group A; 31% group B; 31% group E. Inclusion criteria: primary VV. Exclusion criteria: pregnancy, obesity, thrombophlebitis, skin changes, post‐thrombotic occlusion, sapheno‐popliteal incompetence; systemic medical disease, coagulopathy. Venous problem: saphenofemoral incompetence. Drop‐outs at 10 years: group A = 25; group B = 24; group E = 21.
Interventions	Sclerotherapy with STD (group A, 1 to 2 ml of 2% or 3%) versus sclerotherapy with high dose STD (group B, 3 to 6 ml of 3%) versus foam sclerotherapy (group E, foam + 3% STD).
Outcomes	1. Recurrent varicose veins at 5 and 10 years. 2. Failure rate at 10 years (intention to treat): patients who needed any new intervention at 10 years plus drop‐outs.
Notes	1. Further 3 treatment groups were excluded as these were surgical: multiple ligations, stab avulsions and surgery followed by sclerotherapy. 2. Foam produced by using 0.1 to 0.2 ml J&J‐93FA with 3% STD.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Low risk	A ‐ Adequate

Bukhari 1999

Methods	Hospital‐based study. Duration of recruitment to study: not stated. Duration of follow‐up: 12 weeks. Parallel trial. Randomisation method: not stated. Blinding: patient ‐ yes; doctor ‐ yes; outcome assessor ‐ yes. Cross‐overs: none. Risk of bias: low.
Participants	42 patients. Age: not stated. Sex: not stated. Inclusion criteria: telangiectasia < 1 mm or venulectasia 1 to 3 mm diameter. Exclusion criteria: pregnancy, deep venous thrombosis, chronic venous insufficiency, oedema. Venous problem: as above. Drop‐outs: 7 patients; 2 in hypertonic saline and 5 in lidocaine group.
Interventions	Sclerotherapy with lidocaine/ hypertonic saline (19%) versus hypertonic saline (23.4%).
Outcomes	1. Patient discomfort from initial injection: no pain (score = 1), mild pain (score = 2), moderate pain (score = 3), severe pain (score = 4). 2. Photographic score: disappearance of VV, pigmentation, neovascularization. 3. Complications: microthrombosis, skin necrosis/ulceration.
Notes	Sclerosant: see 'Interventions'. Dose: less than 2 ml. Number of sites: 25 cm2 area. Bandaging technique: elastic bandages or stockings up to 96 hours.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Low risk	A ‐ Adequate

Fraser 1985

Methods	Hospital‐based study. Duration of recruitment to study: 19 months. Duration of follow‐up: 3 months. Parallel trial. Randomisation method: uncertain ‐ random cards. Blinding: patient ‐ no; doctor ‐ no; outcome assessor ‐ no. Cross‐overs: 3 group A to C. Risk of bias: moderate.
Participants	154 patients: 158 legs. Age: matched in all 3 treatment groups (mean 41, 42, 42 years in groups A, B, C). Sex: matched in all. 3 treatment groups (female 73%, 79%, 80% in groups A, B, C). Inclusion criteria: 49 limbs undergone saphenofemoral disconnection 1 month previously. Exclusion criteria: venous ulcer. Venous problem: no superficial venous incompetence. Drop‐outs: 8 legs at 3 months.
Interventions	Sclerotherapy with Coban bandaging for 6 weeks versus Coban 3 days versus crepe 6 weeks.
Outcomes	1. Patient symptom score: cosmetic, tiredness, pain, pruritus, cramps, ankle swelling, eczema (7 = worst score). 2. Symptoms from bandage. 3. Phlebitis at 3 months. 4. Residual VV at 3 months.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Goldman 2002

Methods	Clinic‐based study. Duration of recruitment to study: not stated. Duration of follow‐up: 16 weeks. Parallel trial. Randomisation method: not stated. Blinding: patient ‐ yes; doctor ‐ yes; outcome assessor ‐ yes. Cross‐overs: none reported. Risk of bias: low.
Participants	129 patients. Age: not stated. Sex: not stated. Inclusion criteria: telangiectasia < 1 mm, reticular veins 1 to 3 mm diameter or varicose veins 3 to 6 mm diameter. Exclusion criteria: superficial venous incompetence. Venous problem: as above. Drop‐outs: none reported.
Interventions	Sclerotherapy with polidocanol (0.5%, 1%, 3%) versus STD (0.25%, 0.5%, 1.5%).
Outcomes	1. Photographic score: appearance of veins (range from 1 (worse) to 5 (complete disappearance). 2. Complications: skin necrosis, hyperpigmentation, matting, local urticaria.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Hamel‐Desnos 2003

Methods	Multi‐centre clinic based study. Duration of follow‐up: 12 months. Parallel trial. Randomisation method: uncertain. Blinding: patient ‐ no; doctor ‐ no; outcome assessor ‐ not stated. Cross‐overs: none. Risk of bias: moderate.
Participants	88 patients. Age: 18 to 80 years. Sex: not stated. Inclusion criteria: long saphenous incompetence with LSV diameter 4 to 8 mm. Exclusion criteria: pregnancy, previous DVT, coagulopathy, polidocanol allergy. Venous problem: as inclusion. Drop‐outs: none stated.
Interventions	Sclerotherapy with polidocanol foam (0.5 ml sclerosant) versus 2.0 to 2.5 ml 3% polidocanol liquid.
Outcomes	1. Venous spasm, 2. Cutaneous inflammation at 3 weeks, 3. Elimination of reflux at 3 weeks, 4. Recanalisation at 6 months.
Notes	Single does of sclerosant only: 2.0 ml if LSV 4 to 6 mm diameter; 2.5 ml if LSV 6 to 8 mm diameter.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Kahle 2003

Methods	Hospital‐based study. Duration of recruitment to study: not stated. Duration of follow‐up: 4 weeks. Parallel trial. Randomisation method: not stated. Blinding: patient ‐ yes; doctor ‐ yes; outcome assessor ‐ yes. Cross‐overs: none. Risk of bias: low.
Participants	30 patients. Age: not stated. Sex: not stated. Inclusion criteria: varicose veins 5 to 6 mm diameter. Exclusion criteria: none stated. Venous problem: as above. Drop‐outs: none.
Interventions	Sclerotherapy with 3% aethoxysclerol (polidocanol) versus normal saline.
Outcomes	1. Venous by arterial volume flow.
Notes	2 layer short stretch bandages in both groups. Duplex scan at 1 and 4 weeks post‐sclerotherapy.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Labas 2003

Methods	Hospital‐based study. Duration of recruitment to study: 10 years. Duration of follow‐up: 6 months, 5 years. Parallel trial. Randomisation method: not stated. Blinding: patient ‐ not stated; doctor ‐ not stated; outcome assessor ‐ yes. Cross‐overs: none reported. Risk of bias: moderate.
Participants	1622 patients. Age: not stated. Sex: not stated. Inclusion criteria: not stated. Exclusion criteria: not stated. Venous problem: chronic venous insufficiency. Drop‐outs: none reported.
Interventions	Sclerotherapy with aethoxysclerol (Sigg method) vs STD (Fegan method).
Outcomes	1. Cosmetic appearance, including photographic evidence. 2. Symptoms: cramps, pain, fatigue, heaviness.
Notes	Third group treated with both aethoxysclerol and STD (Fegan method) not discussed further: relative proportion of 2 sclerosants not stated.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Moody 1996

Methods	Hospital‐based study. Duration of recruitment to study: not stated. Duration of follow‐up: 36 months. Parallel trial. Randomisation method: not stated. Blinding: patient ‐ no; doctor ‐ no; outcome assessor ‐ not stated. Cross‐overs: none. Risk of bias: moderate.
Participants	100 patients: 111 legs. Age: not stated. Sex: not stated. Inclusion criteria: not stated. Exclusion criteria: not stated. Venous problem: not stated. Drop‐outs: 0 legs at 3 months; 2 legs at 12 months; 28 legs at 36 months.
Interventions	Sclerotherapy with bandaging for 1 week versus 6 weeks.
Outcomes	1. Patient symptoms‐ tolerating bandage. 2. Complications: staining, pain, phlebitis, blistering, ulceration, induration. 3. Recurrent varicose veins.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Prescott 1992

Methods	Study setting: not stated. Duration of recruitment to study: not stated. Duration of follow‐up: not stated. Parallel trial. Randomisation method: not stated. Blinding: patient ‐ not stated; doctor ‐ not stated; outcome assessor ‐ not stated. Cross‐overs: none. Risk of bias: moderate.
Participants	50 patients. Age: < 50 years. Sex: females. Inclusion criteria: previously treated VV. Exclusion criteria: not stated. Venous problem: telangiectasia < 2 mm diameter. Drop‐outs: none.
Interventions	Sclerotherapy with 10% hypertonic dextrose versus 0.15% STD.
Outcomes	1. Patient assessment: disappearance of thread veins. 2. Injecting surgeon assessment: disappearance of thread veins. 3. Photographic assessment: disappearance of thread veins. 4. Complications: pain, matting, pigmentation.
Notes	Sclerosant: see 'Interventions'. Dose: not stated. Repeat treatments: mean 4.2 (range 2 to 8) in hypertonic dextrose, 2.6 (range 2 to 5) in 0.15% STD. Bandaging technique: not stated.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Raj 1981

Methods	Hospital‐based study. Duration of recruitment to study: not stated. Duration of follow‐up: 6 weeks. Parallel trial. Randomisation method: random envelopes. Blinding: patient ‐ no; doctor ‐ no; outcome assessor ‐ yes. Cross‐overs: none. Risk of bias: moderate.
Participants	112 patients. Age: mean 41.9 years, range 21 to 70 years. Sex: 68 females, 42 males (N.B. totals 110 and not 112). Inclusion criteria: 'symptoms attributable to below knee VV'. Exclusion criteria: eczema, ulceration, obesity. Venous problem: below knee VV with no clinical evidence of saphenofemoral incompetence. Drop‐outs: 12 patients; did not follow instructions or did not attend clinic.
Interventions	Sclerotherapy with bandaging for 8 hours versus 6 weeks.
Outcomes	1. Patient assessment: cosmetic result and symptomatic improvement. 2. Injecting surgeon assessment: cosmetic result. 3. Independent surgeon assessment: cosmetic result. 4. Infrared photography: before and after compared by two independent surgeons (3 = best score, 0 = worst for each assessment; maximum total = 12).
Notes	Sclerosant: 3% STD. Dose: 0.5 ml/site. Number of sites: not stated. Bandaging technique: Sorbo foam rubber pads, crepe, Tubigrip.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Reddy 1986

Methods	Hospital‐based study. Duration of recruitment to study: 2 years. Duration of follow‐up: 4 years. Parallel trial. Randomisation method: not stated. Blinding: patient ‐ no; doctor ‐ no; outcome assessor ‐ yes. Cross‐overs: none. Risk of bias: moderate.
Participants	130 patients: 145 legs. Age: not stated. Sex: not stated. Inclusion criteria: primary or recurrent VV. Exclusion criteria: saphenofemoral or saphenopopliteal incompetence. Venous problem: no saphenofemoral or saphenopopliteal incompetence. Drop‐outs: not stated.
Interventions	Sclerotherapy with bandaging for 1 week versus 3 weeks.
Outcomes	1. Patient questionnaire: pain, mobility, cosmetic appearance, general satisfaction (4 = best score, 11 = worst). 2. Doctor assessment: phlebitis, pigmentation, induration, disappearance of varicosities (3 = best score, 13 = worst).
Notes	Trial 1 refers to Batch 1980 study; trial 2 to Reddy 1986 study. Sclerosant: not stated. Dose: not stated. Number of sites: not stated. Bandaging technique: Sorbo rubber pads, crepe, Elastoplast.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Schadeck 1995a

Methods	Study setting: not stated. Duration of recruitment to study: not stated. Duration of follow‐up: 3 minutes. Parallel trial. Randomisation method: not stated. Blinding: patient ‐ not stated; doctor ‐ not stated; outcome assessor ‐ not stated. Cross‐overs: none. Risk of bias: moderate.
Participants	30 patients. Age: not stated. Sex: not stated. Inclusion criteria: long saphenous vein < 6 mm diameter. Exclusion criteria: long saphenous vein > 6 mm diameter (Duplex ultrasound). Venous problem: long saphenous reflux. Drop‐outs: not stated.
Interventions	Sclerotherapy with 4% aetoxisclerol versus 3% Sotradecol (STD).
Outcomes	1. Venous spasm (75% reduction cross‐sectional diameter) at 3 minutes. 2. Disappearance of long saphenous reflux.
Notes	Sclerosant: see 'Interventions'. Number of treatments: 2. N.B. Figures used in the analyses were estimates from percentages quoted in the text.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Scurr 1985

Methods	Hospital‐based study. Duration of recruitment to study: not stated. Duration of follow‐up: 6 weeks (see Note 1). Parallel trial. Randomisation method: not stated. Blinding: patient ‐ no; doctor ‐ no; outcome assessor ‐ yes. Cross‐overs: none. Risk of bias: moderate.
Participants	42 patients (see Note 2). Age: mean 52.6 years, range 42 to 69 years in men; mean 43.2 years, range 28 to 60 years in women. Sex: 33 females, 9 males. Inclusion criteria: unilateral or bilateral VV. Exclusion criteria: saphenofemoral incompetence or high thigh perforating veins. Venous problem: no saphenofemoral incompetence. Drop‐outs: none.
Interventions	Sclerotherapy with elastic stocking compression versus conventional bandaging.
Outcomes	1. Successful sclerosis: 100%, 75 to 99%, 50 to 74%, < 50%. 2. Thrombophlebitis: 0%, 1 to 25%, 26 to 50%, > 50%. 3. Skin staining: 0%, 1 to 25%, 26 to 50%, > 50%.
Notes	Sclerosant: 0.5% ethanolamine. Dose: 0.5 ml/site. Number of sites: maximum 6. Bandaging technique: Struva Forte stocking versus Elastocrepe/ Elastoplast. (1) Patients assessed at 3 and 6 weeks but not clearly stated which time results refer to ‐ presume 6 weeks. (2) Results show 42 limbs in each treatment group therefore all patients must have had bilateral VV.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Shouler 1989

Methods	Hospital‐based study. Duration of recruitment to study: not stated. Duration of follow‐up: 6 weeks. Parallel trial. Randomisation method: numbered sealed envelopes. Blinding: patient ‐ no; doctor ‐ no; outcome assessor ‐ no. Cross‐overs: none. Risk of bias: moderate.
Participants	62 patients. Age: mean 39.3, range 24 to 67 in stocking group; mean 39.7, range 17 to 71 in bandage/stocking group. Sex: 45 females, 17 males. Inclusion criteria: primary varicose veins and residual varicosities following surgery. Exclusion criteria: saphenofemoral or saphenopopliteal incompetence. Venous problem: as above. Drop‐outs: none.
Interventions	Sclerotherapy with Elastocrepe bandage and elastic stocking compression versus elastic stocking alone.
Outcomes	1. Patient assessment: discomfort, slipping of dressing. 2. Disappearance of varicosities: good, fair. 3. Complications: thrombophlebitis.
Notes	Sclerosant: STD. Dose: not stated. Number of sites: mean 3.6 in bandage/stocking group, 3.2 in stocking group. Bandaging technique: Brevet Varex and Elastocrepe versus Brevet Varex.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Stanley 1991

Methods	Hospital‐based study. Duration of recruitment to study: 6 months. Duration of follow‐up: 6 months. Parallel trial. Randomisation method: not stated. Blinding: patient ‐ no; doctor ‐ no; outcome assessor ‐ no. Cross‐overs: none. Risk of bias: moderate.
Participants	102 patients: 51 each group. Age: mean 55.7 years, range 24 to 69 years in Molefoam group; mean 60.1 years, range 31 to 68 years in Sorbo pad group. Sex: 37 females, 14 males in Molefoam group: 36 females, 15 males in Sorbo pad group. Inclusion criteria: not stated. Exclusion criteria: not stated. Venous problem: not stated. Drop‐outs: none.
Interventions	Sclerotherapy with Molefoam dressing to injection site versus Sorbo pad.
Outcomes	1. Successful sclerosis (no further injections required). 2. Ulceration following sclerotherapy. 3. Skin erythema.
Notes	Sclerosant: STD. Dose: 0.5 ml/site. Number of sites: mean 4.38 in Molefoam, 3.88 in Sorbo pad groups. Bandaging technique: Elastocrepe/Elastoplast/Tubigrip.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

LSV long saphenous vein
STD sodium tetradecyl sulphate
VV varicose veins

Characteristics of excluded studies [ordered by study ID]

Ir a:

estudios incluidos

Study	Reason for exclusion
Ariyoshi 1996	RCT comparing surgery and sclerotherapy to sclerotherapy alone.
Belcaro 1991	RCT comparing local anaesthetic section of varicose veins (dentist's technique), sclerotherapy and 'Section Ambulatoire des Varices avec Sclerotherapie' (SAVAS) (combination of dentist's technique and sclerotherapy).
Belcaro 2003a	RCT comparing sclerotherapy with aethoxysclerol versus STD. No details of randomisation, blinding or allocation concealment presented. Number of patients/limbs entering trial not stated, only numbers of limbs assessed at 10‐year follow‐up: drop‐outs impossible to assess. Results presented as percentages: unclear as to the denominator. Abstract states that aethoxysclerol is more effective and better tolerated than STD (Anova p<0.021).
Bountouroglou 2004	RCT comparing foam sclerotherapy and adjuvant high saphenous ligation under local anaesthetic with conventional surgery.
Chant 1972	RCT comparing surgery to sclerotherapy.
De Roos 2003	RCT comparing surgery (ambulatory phlebectomy) to sclerotherapy.
Doran 1975	RCT comparing surgery to sclerotherapy.
Einarsson 1993	RCT comparing surgery to sclerotherapy.
Hobbs 1968	RCT comparing surgery to sclerotherapy.
Ikeda 1996	RCT comparing surgery to sclerotherapy.
Iwamoto 2003	RCT comparing surgery with intra‐operative sclerotherapy to surgery with post‐operative sclerotherapy.
Jakobsen 1979	RCT comparing surgery to sclerotherapy.
Kanter 1992	Not an RCT. Controlled study comparing Sotradecol (STD) sclerotherapy with or without heparin.
Leach 2003	Not an RCT. Controlled study where 13 patients with bilateral telangiectatic veins (0.2 to 0.4 mm diameter) were treated with 0.25% STD in one leg and 72% glycerine in the contralateral leg.
Lupton 2002	Not an RCT. Controlled study where 20 women with bilateral telangiectatic veins (0.1 to 1.5 mm diameter) were treated with a long‐pulsed 1064 nm Nd:YAG laser to one leg and sclerotherapy with 0.25% STD in the contralateral leg. Results favoured treatment with sclerotherapy.
Martimbeau 1995	Double‐blind trial of sclerotherapy with iodine sodium iodide versus sodium tetradecyl sulphate. No evidence of randomisation in study methods and no results reported of differences between the two sclerosants.
Martimbeau 2003	RCT comparing sclerotherapy with 1% STD foam versus liquid formulation. Randomisation method not stated, unable to assess blinding or allocation concealment. End point data unclear.
Martimbeau 2003b	RCT comparing sclerotherapy with 1% STD as an air‐filled foam versus perfluoropropane‐filled albumin microspheres of STD. Randomisation method not stated, unable to assess blinding or allocation concealment. No numerical data reported, only statistical significance. Trend towards benefit with perfluopropane‐filled albumin microspheres group.
Mosley 1998	Not an RCT. Controlled study where below‐knee incompetent perforating vein treated with varying doses of 5% ethanolamine and contralateral limb treated with normal saline.
Queral 1990	Not an RCT. Alternate assignment of 28 patients with venous ulceration to either Unna's compressive boots alone or in conjunction with sclerotherapy.
Rutgers 1994	RCT comparing surgery to sclerotherapy.
Sadick 1991	Not an RCT. Double‐blind paired‐comparison study in patients with bilateral starburst telangiectasia and reticular veins. Phase 1: comparison of varying concentrations of hypertonic saline (23.4%, 11.7%, 5.8%) in 600 patients. Phase 2: subgroup of 200 patients treated with hypertonic saline ± heparin.
Schadeck 1995b	RCT comparing sclerotherapy of the terminal segment of the long saphenous vein (LSV) with sclerotherapy of LSV tributaries in addition to this. Excluded because no numerical results presented, although results state that treating tributaries prevents early recanalisation of the long saphenous vein.
Scultetus 2003	RCT comparing sclerotherapy to sclerotherapy with post‐operative microthrombectomy.
Seddon 1973	RCT comparing surgery to sclerotherapy: inadequate method of randomisation (alternate patients assigned to each treatment option).
Wright 2003	RCT comparing sclerotherapy with polidocanol foam (Varisolve) with surgery or sclerotherapy. Excluded because no numerical results presented, although abstract states that foam sclerotherapy is as effective as surgery and more effective than conventional sclerotherapy.
Zeh 2003	RCT comparing sclerotherapy with polidocanol foam to sclerotherapy with polidocanol foam with 0.1 cm2 Gelofusine (a synthetic plasma expander). Excluded because: i) randomization method, blinding and allocation concealment are unclear; ii) no results published on the effect of treatment on venous spasm and reflux, as mentioned in the Methods; iii) it is not clear whether the results indicating number of veins sclerosed apply to immediately post‐treatment or the 1 month follow‐up.

Surgical treatment of varicose veins is beyond the scope of this Cochrane Review.

Data and analyses

Open in table viewer

Comparison 1. Sclerotherapy with different sclerosants

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Results: venous spasm Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.1

Comparison 1 Sclerotherapy with different sclerosants, Outcome 1 Results: venous spasm.

2 Results: disappearance of reflux Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.2

Comparison 1 Sclerotherapy with different sclerosants, Outcome 2 Results: disappearance of reflux.

3 Results: venous by arterial volume flow Show forest plot

Other data

No numeric data

Analysis 1.3


Study	Time point	3% aethoxysclerol	Sodium chloride
Kahle 2003	Pre‐treatment	1.39 (95% CI 1.13 to 1.52)	1.41 (95% CI 1.15 to 1.67)
Kahle 2003	After 1 week	1.08 (95% CI 0.95 to 1.21)	1.39 (95% CI 1.16 to 1.62)
Kahle 2003	After 2 weeks	1.18 (95% CI 0.99 to 1.37)	1.41 (95% CI 1.11 to 1.71)

Comparison 1 Sclerotherapy with different sclerosants, Outcome 3 Results: venous by arterial volume flow.

4 Results: disappearance of thread veins Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.4

Comparison 1 Sclerotherapy with different sclerosants, Outcome 4 Results: disappearance of thread veins.

5 Results: photographic appearance of veins Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 1.5

Comparison 1 Sclerotherapy with different sclerosants, Outcome 5 Results: photographic appearance of veins.

6 Results: cosmetic appearance at 6 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 1.6

Comparison 1 Sclerotherapy with different sclerosants, Outcome 6 Results: cosmetic appearance at 6 months.

7 Results: cosmetic appearance at 5 years Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 1.7

Comparison 1 Sclerotherapy with different sclerosants, Outcome 7 Results: cosmetic appearance at 5 years.

8 Results: symptomatic improvement at 6 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 1.8

Comparison 1 Sclerotherapy with different sclerosants, Outcome 8 Results: symptomatic improvement at 6 months.

9 Results: symptomatic improvement at 5 years Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 1.9

Comparison 1 Sclerotherapy with different sclerosants, Outcome 9 Results: symptomatic improvement at 5 years.

10 Results: recurrent varicose veins at 5 years Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.10

Comparison 1 Sclerotherapy with different sclerosants, Outcome 10 Results: recurrent varicose veins at 5 years.

11 Results: recurrent varicose veins at 10 years Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.11

Comparison 1 Sclerotherapy with different sclerosants, Outcome 11 Results: recurrent varicose veins at 10 years.

12 Results: failure at 10 years Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.12

Comparison 1 Sclerotherapy with different sclerosants, Outcome 12 Results: failure at 10 years.

13 Complications: allergic reaction Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.13

Comparison 1 Sclerotherapy with different sclerosants, Outcome 13 Complications: allergic reaction.

14 Complications: pigmentation Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.14

Comparison 1 Sclerotherapy with different sclerosants, Outcome 14 Complications: pigmentation.

15 Complications: pigmentation Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.15

Comparison 1 Sclerotherapy with different sclerosants, Outcome 15 Complications: pigmentation.

16 Complications: skin necrosis Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.16

Comparison 1 Sclerotherapy with different sclerosants, Outcome 16 Complications: skin necrosis.

17 Complications: local urticaria Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.17

Comparison 1 Sclerotherapy with different sclerosants, Outcome 17 Complications: local urticaria.

18 Complications: pain Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.18

Comparison 1 Sclerotherapy with different sclerosants, Outcome 18 Complications: pain.

19 Complications: vein thrombosis Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.19

Comparison 1 Sclerotherapy with different sclerosants, Outcome 19 Complications: vein thrombosis.

20 Complications: ecchymosis Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.20

Comparison 1 Sclerotherapy with different sclerosants, Outcome 20 Complications: ecchymosis.

21 Complications: matting Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.21

Comparison 1 Sclerotherapy with different sclerosants, Outcome 21 Complications: matting.

22 Complications: matting Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected

Analysis 1.22

Comparison 1 Sclerotherapy with different sclerosants, Outcome 22 Complications: matting.

Open in table viewer

Comparison 2. Local anaesthetic in sclerosant versus no local anaesthetic

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Results: disappearance of varicosities, pigmentation, neovascularization Show forest plot	1	35	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
Open in figure viewer Analysis 2.1 Comparison 2 Local anaesthetic in sclerosant versus no local anaesthetic, Outcome 1 Results: disappearance of varicosities, pigmentation, neovascularization.
2 Complications: moderate or severe pain from sclerotherapy Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.2 Comparison 2 Local anaesthetic in sclerosant versus no local anaesthetic, Outcome 2 Complications: moderate or severe pain from sclerotherapy.
3 Complications: microthrombosis Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.3 Comparison 2 Local anaesthetic in sclerosant versus no local anaesthetic, Outcome 3 Complications: microthrombosis.
4 Complications: ulceration Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.4 Comparison 2 Local anaesthetic in sclerosant versus no local anaesthetic, Outcome 4 Complications: ulceration.
5 Complications: matting/hyperpigmentation Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.5 Comparison 2 Local anaesthetic in sclerosant versus no local anaesthetic, Outcome 5 Complications: matting/hyperpigmentation.

Open in table viewer

Comparison 3. Sclerotherapy with foam versus liquid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Results: venous spasm Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.1 Comparison 3 Sclerotherapy with foam versus liquid, Outcome 1 Results: venous spasm.
2 Results: elimination of reflux Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.2 Comparison 3 Sclerotherapy with foam versus liquid, Outcome 2 Results: elimination of reflux.
3 Results: recanalisation at 6 months Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.3 Comparison 3 Sclerotherapy with foam versus liquid, Outcome 3 Results: recanalisation at 6 months.
4 Results: recurrent varicose veins at 10 years Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.4 Comparison 3 Sclerotherapy with foam versus liquid, Outcome 4 Results: recurrent varicose veins at 10 years.
5 Results: failure at 10 years Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.5 Comparison 3 Sclerotherapy with foam versus liquid, Outcome 5 Results: failure at 10 years.
6 Complications: haematoma Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.6 Comparison 3 Sclerotherapy with foam versus liquid, Outcome 6 Complications: haematoma.
7 Complications: cutaneous inflammation at 3 weeks Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.7 Comparison 3 Sclerotherapy with foam versus liquid, Outcome 7 Complications: cutaneous inflammation at 3 weeks.
8 Results: recurrent varicose veins at 5 years Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.8 Comparison 3 Sclerotherapy with foam versus liquid, Outcome 8 Results: recurrent varicose veins at 5 years.

Open in table viewer

Comparison 4. Molefoam versus Sorbo pad to injection sites after sclerotherapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Results: successful sclerotherapy Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 4.1 Comparison 4 Molefoam versus Sorbo pad to injection sites after sclerotherapy, Outcome 1 Results: successful sclerotherapy.
2 Complications: erythema Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 4.2 Comparison 4 Molefoam versus Sorbo pad to injection sites after sclerotherapy, Outcome 2 Complications: erythema.
3 Complications: ulceration Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 4.3 Comparison 4 Molefoam versus Sorbo pad to injection sites after sclerotherapy, Outcome 3 Complications: ulceration.

Open in table viewer

Comparison 5. Increased elastic compression versus conventional dressing after sclerotherapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Results: disappearance of varicosities Show forest plot	3	246	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.25 [0.71, 2.20]
Open in figure viewer Analysis 5.1 Comparison 5 Increased elastic compression versus conventional dressing after sclerotherapy, Outcome 1 Results: disappearance of varicosities.
2 Complications: discomfort Show forest plot	2	168	Peto Odds Ratio (Peto, Fixed, 95% CI)	3.65 [1.92, 6.95]
Open in figure viewer Analysis 5.2 Comparison 5 Increased elastic compression versus conventional dressing after sclerotherapy, Outcome 2 Complications: discomfort.
3 Complications: slipped stockings Show forest plot	2	168	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.49 [0.24, 1.00]
Open in figure viewer Analysis 5.3 Comparison 5 Increased elastic compression versus conventional dressing after sclerotherapy, Outcome 3 Complications: slipped stockings.
4 Complications: thrombophlebitis Show forest plot	3	246	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.79 [0.47, 1.34]
Open in figure viewer Analysis 5.4 Comparison 5 Increased elastic compression versus conventional dressing after sclerotherapy, Outcome 4 Complications: thrombophlebitis.
5 Complications: skin staining Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 5.5 Comparison 5 Increased elastic compression versus conventional dressing after sclerotherapy, Outcome 5 Complications: skin staining.

Open in table viewer

Comparison 6. Short‐term versus standard bandaging after sclerotherapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Results: cosmetic and symptomatic improvement Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 6.1 Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 1 Results: cosmetic and symptomatic improvement.
2 Results: pain, mobility, cosmetic appearance, satisfaction at 3 months Show forest plot	2	298	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
Open in figure viewer Analysis 6.2 Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 2 Results: pain, mobility, cosmetic appearance, satisfaction at 3 months.
3 Results: recurrent varicose veins Show forest plot	3	416	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.69 [0.43, 1.10]
Open in figure viewer Analysis 6.3 Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 3 Results: recurrent varicose veins.
4 Results: pain, mobility, cosmetic appearance, satisfaction at 2 years Show forest plot	1	145	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
Open in figure viewer Analysis 6.4 Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 4 Results: pain, mobility, cosmetic appearance, satisfaction at 2 years.
5 Results: pain, mobility, cosmetic appearance, satisfaction at 4 years Show forest plot	1	145	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
Open in figure viewer Analysis 6.5 Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 5 Results: pain, mobility, cosmetic appearance, satisfaction at 4 years.
6 Complications: phlebitis, pigmentation, induration at 3 months Show forest plot	2	298	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
Open in figure viewer Analysis 6.6 Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 6 Complications: phlebitis, pigmentation, induration at 3 months.
7 Complications: phlebitis, staining, pain, blistering, ulceration Show forest plot	2	331	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.06 [0.66, 1.73]
Open in figure viewer Analysis 6.7 Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 7 Complications: phlebitis, staining, pain, blistering, ulceration.
8 Complications: discomfort, slipping, foot swelling, bandage intolerance Show forest plot	2	216	Risk Ratio (M‐H, Fixed, 95% CI)	0.54 [0.40, 0.73]
Open in figure viewer Analysis 6.8 Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 8 Complications: discomfort, slipping, foot swelling, bandage intolerance.

Open in table viewer

Comparison 7. Sclerotherapy versus graduated compression stockings

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Results: cosmetic and symptomatic improvement Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 7.1 Comparison 7 Sclerotherapy versus graduated compression stockings, Outcome 1 Results: cosmetic and symptomatic improvement.

Analysis 1.1

Comparison 1 Sclerotherapy with different sclerosants, Outcome 1 Results: venous spasm.

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Analysis 1.2

Comparison 1 Sclerotherapy with different sclerosants, Outcome 2 Results: disappearance of reflux.

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Study	Time point	3% aethoxysclerol	Sodium chloride
Kahle 2003	Pre‐treatment	1.39 (95% CI 1.13 to 1.52)	1.41 (95% CI 1.15 to 1.67)
Kahle 2003	After 1 week	1.08 (95% CI 0.95 to 1.21)	1.39 (95% CI 1.16 to 1.62)
Kahle 2003	After 2 weeks	1.18 (95% CI 0.99 to 1.37)	1.41 (95% CI 1.11 to 1.71)

Analysis 1.3

Comparison 1 Sclerotherapy with different sclerosants, Outcome 3 Results: venous by arterial volume flow.

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Analysis 1.4

Comparison 1 Sclerotherapy with different sclerosants, Outcome 4 Results: disappearance of thread veins.

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Analysis 1.5

Comparison 1 Sclerotherapy with different sclerosants, Outcome 5 Results: photographic appearance of veins.

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Analysis 1.6

Comparison 1 Sclerotherapy with different sclerosants, Outcome 6 Results: cosmetic appearance at 6 months.

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Analysis 1.7

Comparison 1 Sclerotherapy with different sclerosants, Outcome 7 Results: cosmetic appearance at 5 years.

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Analysis 1.8

Comparison 1 Sclerotherapy with different sclerosants, Outcome 8 Results: symptomatic improvement at 6 months.

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Analysis 1.9

Comparison 1 Sclerotherapy with different sclerosants, Outcome 9 Results: symptomatic improvement at 5 years.

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Analysis 1.10

Comparison 1 Sclerotherapy with different sclerosants, Outcome 10 Results: recurrent varicose veins at 5 years.

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Analysis 1.11

Comparison 1 Sclerotherapy with different sclerosants, Outcome 11 Results: recurrent varicose veins at 10 years.

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Analysis 1.12

Comparison 1 Sclerotherapy with different sclerosants, Outcome 12 Results: failure at 10 years.

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Analysis 1.13

Comparison 1 Sclerotherapy with different sclerosants, Outcome 13 Complications: allergic reaction.

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Analysis 1.14

Comparison 1 Sclerotherapy with different sclerosants, Outcome 14 Complications: pigmentation.

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Analysis 1.15

Comparison 1 Sclerotherapy with different sclerosants, Outcome 15 Complications: pigmentation.

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Analysis 1.16

Comparison 1 Sclerotherapy with different sclerosants, Outcome 16 Complications: skin necrosis.

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Analysis 1.17

Comparison 1 Sclerotherapy with different sclerosants, Outcome 17 Complications: local urticaria.

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Analysis 1.18

Comparison 1 Sclerotherapy with different sclerosants, Outcome 18 Complications: pain.

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Analysis 1.19

Comparison 1 Sclerotherapy with different sclerosants, Outcome 19 Complications: vein thrombosis.

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Analysis 1.20

Comparison 1 Sclerotherapy with different sclerosants, Outcome 20 Complications: ecchymosis.

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Analysis 1.21

Comparison 1 Sclerotherapy with different sclerosants, Outcome 21 Complications: matting.

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Analysis 1.22

Comparison 1 Sclerotherapy with different sclerosants, Outcome 22 Complications: matting.

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Analysis 2.1

Comparison 2 Local anaesthetic in sclerosant versus no local anaesthetic, Outcome 1 Results: disappearance of varicosities, pigmentation, neovascularization.

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Analysis 2.2

Comparison 2 Local anaesthetic in sclerosant versus no local anaesthetic, Outcome 2 Complications: moderate or severe pain from sclerotherapy.

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Analysis 2.3

Comparison 2 Local anaesthetic in sclerosant versus no local anaesthetic, Outcome 3 Complications: microthrombosis.

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Analysis 2.4

Comparison 2 Local anaesthetic in sclerosant versus no local anaesthetic, Outcome 4 Complications: ulceration.

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Analysis 2.5

Comparison 2 Local anaesthetic in sclerosant versus no local anaesthetic, Outcome 5 Complications: matting/hyperpigmentation.

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Analysis 3.1

Comparison 3 Sclerotherapy with foam versus liquid, Outcome 1 Results: venous spasm.

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Analysis 3.2

Comparison 3 Sclerotherapy with foam versus liquid, Outcome 2 Results: elimination of reflux.

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Analysis 3.3

Comparison 3 Sclerotherapy with foam versus liquid, Outcome 3 Results: recanalisation at 6 months.

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Analysis 3.4

Comparison 3 Sclerotherapy with foam versus liquid, Outcome 4 Results: recurrent varicose veins at 10 years.

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Analysis 3.5

Comparison 3 Sclerotherapy with foam versus liquid, Outcome 5 Results: failure at 10 years.

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Analysis 3.6

Comparison 3 Sclerotherapy with foam versus liquid, Outcome 6 Complications: haematoma.

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Analysis 3.7

Comparison 3 Sclerotherapy with foam versus liquid, Outcome 7 Complications: cutaneous inflammation at 3 weeks.

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Analysis 3.8

Comparison 3 Sclerotherapy with foam versus liquid, Outcome 8 Results: recurrent varicose veins at 5 years.

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Analysis 4.1

Comparison 4 Molefoam versus Sorbo pad to injection sites after sclerotherapy, Outcome 1 Results: successful sclerotherapy.

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Analysis 4.2

Comparison 4 Molefoam versus Sorbo pad to injection sites after sclerotherapy, Outcome 2 Complications: erythema.

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Analysis 4.3

Comparison 4 Molefoam versus Sorbo pad to injection sites after sclerotherapy, Outcome 3 Complications: ulceration.

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Analysis 5.1

Comparison 5 Increased elastic compression versus conventional dressing after sclerotherapy, Outcome 1 Results: disappearance of varicosities.

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Analysis 5.2

Comparison 5 Increased elastic compression versus conventional dressing after sclerotherapy, Outcome 2 Complications: discomfort.

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Analysis 5.3

Comparison 5 Increased elastic compression versus conventional dressing after sclerotherapy, Outcome 3 Complications: slipped stockings.

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Analysis 5.4

Comparison 5 Increased elastic compression versus conventional dressing after sclerotherapy, Outcome 4 Complications: thrombophlebitis.

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Analysis 5.5

Comparison 5 Increased elastic compression versus conventional dressing after sclerotherapy, Outcome 5 Complications: skin staining.

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Analysis 6.1

Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 1 Results: cosmetic and symptomatic improvement.

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Analysis 6.2

Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 2 Results: pain, mobility, cosmetic appearance, satisfaction at 3 months.

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Analysis 6.3

Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 3 Results: recurrent varicose veins.

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Analysis 6.4

Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 4 Results: pain, mobility, cosmetic appearance, satisfaction at 2 years.

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Analysis 6.5

Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 5 Results: pain, mobility, cosmetic appearance, satisfaction at 4 years.

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Analysis 6.6

Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 6 Complications: phlebitis, pigmentation, induration at 3 months.

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Analysis 6.7

Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 7 Complications: phlebitis, staining, pain, blistering, ulceration.

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Analysis 6.8

Comparison 6 Short‐term versus standard bandaging after sclerotherapy, Outcome 8 Complications: discomfort, slipping, foot swelling, bandage intolerance.

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Analysis 7.1

Comparison 7 Sclerotherapy versus graduated compression stockings, Outcome 1 Results: cosmetic and symptomatic improvement.

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Comparison 1. Sclerotherapy with different sclerosants

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Results: venous spasm Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

2 Results: disappearance of reflux Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

3 Results: venous by arterial volume flow Show forest plot			Other data	No numeric data

4 Results: disappearance of thread veins Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

5 Results: photographic appearance of veins Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

6 Results: cosmetic appearance at 6 months Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

7 Results: cosmetic appearance at 5 years Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

8 Results: symptomatic improvement at 6 months Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

9 Results: symptomatic improvement at 5 years Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

10 Results: recurrent varicose veins at 5 years Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

11 Results: recurrent varicose veins at 10 years Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

12 Results: failure at 10 years Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

13 Complications: allergic reaction Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

14 Complications: pigmentation Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

15 Complications: pigmentation Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

16 Complications: skin necrosis Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

17 Complications: local urticaria Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

18 Complications: pain Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

19 Complications: vein thrombosis Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

20 Complications: ecchymosis Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

21 Complications: matting Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

22 Complications: matting Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

Comparison 1. Sclerotherapy with different sclerosants

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Comparison 2. Local anaesthetic in sclerosant versus no local anaesthetic

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Results: disappearance of varicosities, pigmentation, neovascularization Show forest plot	1	35	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

2 Complications: moderate or severe pain from sclerotherapy Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

3 Complications: microthrombosis Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

4 Complications: ulceration Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

5 Complications: matting/hyperpigmentation Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

Comparison 2. Local anaesthetic in sclerosant versus no local anaesthetic

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Comparison 3. Sclerotherapy with foam versus liquid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Results: venous spasm Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

2 Results: elimination of reflux Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

3 Results: recanalisation at 6 months Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

4 Results: recurrent varicose veins at 10 years Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

5 Results: failure at 10 years Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

6 Complications: haematoma Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

7 Complications: cutaneous inflammation at 3 weeks Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

8 Results: recurrent varicose veins at 5 years Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

Comparison 3. Sclerotherapy with foam versus liquid

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Comparison 4. Molefoam versus Sorbo pad to injection sites after sclerotherapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Results: successful sclerotherapy Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

2 Complications: erythema Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

3 Complications: ulceration Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

Comparison 4. Molefoam versus Sorbo pad to injection sites after sclerotherapy

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Comparison 5. Increased elastic compression versus conventional dressing after sclerotherapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Results: disappearance of varicosities Show forest plot	3	246	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.25 [0.71, 2.20]

2 Complications: discomfort Show forest plot	2	168	Peto Odds Ratio (Peto, Fixed, 95% CI)	3.65 [1.92, 6.95]

3 Complications: slipped stockings Show forest plot	2	168	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.49 [0.24, 1.00]

4 Complications: thrombophlebitis Show forest plot	3	246	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.79 [0.47, 1.34]

5 Complications: skin staining Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

Comparison 5. Increased elastic compression versus conventional dressing after sclerotherapy

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Comparison 6. Short‐term versus standard bandaging after sclerotherapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Results: cosmetic and symptomatic improvement Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

2 Results: pain, mobility, cosmetic appearance, satisfaction at 3 months Show forest plot	2	298	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

3 Results: recurrent varicose veins Show forest plot	3	416	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.69 [0.43, 1.10]

4 Results: pain, mobility, cosmetic appearance, satisfaction at 2 years Show forest plot	1	145	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

5 Results: pain, mobility, cosmetic appearance, satisfaction at 4 years Show forest plot	1	145	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

6 Complications: phlebitis, pigmentation, induration at 3 months Show forest plot	2	298	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

7 Complications: phlebitis, staining, pain, blistering, ulceration Show forest plot	2	331	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.06 [0.66, 1.73]

8 Complications: discomfort, slipping, foot swelling, bandage intolerance Show forest plot	2	216	Risk Ratio (M‐H, Fixed, 95% CI)	0.54 [0.40, 0.73]

Comparison 6. Short‐term versus standard bandaging after sclerotherapy

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Comparison 7. Sclerotherapy versus graduated compression stockings

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Results: cosmetic and symptomatic improvement Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 7. Sclerotherapy versus graduated compression stockings

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Referencias

Referencias de los estudios incluidos en esta revisión

Abramowitz 1973 {published data only}

Batch 1980 {published data only}

Belcaro 2003b {published data only}

Bukhari 1999 {published data only}

Fraser 1985 {published data only}

Goldman 2002 {published data only}

Hamel‐Desnos 2003 {published data only}

Kahle 2003 {published data only}

Labas 2003 {published data only}

Moody 1996 {published data only}

Prescott 1992 {published data only}

Raj 1981 {published data only}

Reddy 1986 {published data only}

Schadeck 1995a {published data only}

Scurr 1985 {published data only}

Shouler 1989 {published data only}

Stanley 1991 {published data only}

Referencias de los estudios excluidos de esta revisión

Ariyoshi 1996 {published data only}

Belcaro 1991 {published data only}

Belcaro 2003a {published data only}

Bountouroglou 2004 {published data only}

Chant 1972 {published data only}

De Roos 2003 {published data only}

Doran 1975 {published data only}

Einarsson 1993 {published data only}

Hobbs 1968 {published data only}

Ikeda 1996 {published data only}

Iwamoto 2003 {published data only}

Jakobsen 1979 {published data only}

Kanter 1992 {published data only}

Leach 2003 {published data only}

Lupton 2002 {published data only}

Martimbeau 1995 {published data only}

Martimbeau 2003 {published data only}

Martimbeau 2003b {published data only}

Mosley 1998 {published data only}

Queral 1990 {published data only}

Rutgers 1994 {published data only}

Sadick 1991 {published data only}

Schadeck 1995b {published data only}

Scultetus 2003 {published data only}

Seddon 1973 {published data only}

Wright 2003 {published data only}

Zeh 2003 {published data only}

Referencias adicionales

Allan 2000

Bradbury 1999

Brand 1998

Callam 1994

Chassaignac 1855

Fegan 1963

Feied 1999

Frullini 2002

Galland 1998

Mulrow 2006

Rigby 2004

Young 1998

Referencias de otras versiones publicadas de esta revisión

Tisi 2002

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

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