Varicose veins are the most common venous disease in German-speaking countries. Choosing an adequate therapy depends on the localisation, the size and the extent of varicose veins as well as on the presence of venous reflux. The aim of this systematic review is to evaluate the evidence concerning efficacy and safety of various treatment options for varicose veins. Therefore, we compared conservative therapy, surgery, sclerotherapy and endovenous thermal interventions, such as laser therapy and radiofrequency ablation, to one another. Additionally we tried to define a boarder between medically necessary versus cosmetically desired interventions.

We conducted a comprehensive literature search that identified 16 references that met our inclusion criteria. Seven systematic reviews were identified via ten references. The other six references displayed the results of six randomised controlled trials. In total, we conducted nine comparisons of various therapeutic options with regard to pre-defined outcomes in terms of efficacy and safety. We could not draw definite conclusions for some outcomes due to the absence or lack of evidence as well as inconclusive or controversial results.

Overall, the evidence indicates that minimally-invasive thermal therapies are not inferior to surgery in terms of efficacy and safety. Moreover, endovenous laser therapy and endovenous radiofrequency ablation appear to be comparable concerning efficacy and safety outcomes. However, a standardised procedure and a minimum quantity of procedures performed per surgeon need to be established. Based on this review, it is not possible to define a border between medically necessary (invasive or minimally-invasive) versus cosmetically desired (invasive or minimally-invasive) interventions.