In the management of varicose veins, which intervention has been shown in the CLASS trial and NICE TA232 guidelines to be preferred over conventional surgery for primary uncomplicated great saphenous vein reflux?
- A Foam sclerotherapy (UGFS)
- B Endothermal ablation (endovenous laser therapy or radiofrequency ablation) ✓
- C High ligation and stripping (HLS) of the great saphenous vein
- D Compression stockings alone as definitive treatment
Explanation
NICE TA232 (2013) and the CLASS RCT recommend endothermal ablation techniques (endovenous laser treatment [EVLT] or radiofrequency ablation [RFA]) as first-line treatment for truncal varicose veins with confirmed great saphenous vein reflux, ahead of surgery and ultrasound-guided foam sclerotherapy (UGFS). Endothermal ablation offers faster recovery, lower complication rates (nerve injury, wound infection), better quality of life scores, and comparable long-term efficacy to surgical stripping. Foam sclerotherapy is second-line (reserved when ablation is unsuitable). Compression stockings do not treat the underlying reflux.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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