OBJECTIVES: Endovenous laser ablation (EVLA) of the great saphenous vein (GSV) may be combined with tributary vein (TV) treatment either during the same session or in a staged manner with deferred foam sclerotherapy (FS) or miniphlebectomy. Despite recent multi-society guidelines favouring a concomitant approach, evidence supporting this recommendation remains limited, and patient profiles best suited for each strategy are not well defined. This study aimed to compare clinical outcomes, quality of life and patient-reported results following EVLA with either simultaneous or delayed FS, and to assess whether one strategy offers a clear advantage. METHODS: The study included 152 patients with C2-C4 chronic venous disease, allocated to two groups. The concomitant group (CG, n=75) underwent EVLA with simultaneous FS of TV, while the staged group (SG, n=77) received FS three months after EVLA only if necessary due to inadequate TV regression. Treatment allocation followed a shared decision-making process after detailed patient counseling. Follow-up assessments were conducted at 7 days, 1, 3, and 6 months post-EVLA, with analysis of TV regression and procedural characteristics. RESULTS: Complete anatomical success of GSV ablation was achieved in all patients. After 6 months, CG demonstrated greater improvement in Chronic Venous Insufficiency Questionnaire CIVIQ-20). Venous Clinical Severity Score (rVCSS) and Aberdeen Varicose Veins Questionnaire (AVVQ) were comparable at 6 months follow up. At 3 months, CG showed fewer and shorter incompetent TV, although this difference was no longer observed at 6 months. Patients satisfaction was comparable between groups. In SG, 36(46%) of patients required no additional FS. When FS was necessary in SG, lower sclerosant volumes and concentrations were used, treated tributary segments were shorter, and the incidence of hyperpigmentation was significantly reduced. CONCLUSIONS: Deferring tributary vein treatment after EVLA limits the extent of intervention, reduces sclerosant use, and lowers the risk of hyperpigmentation. Both simultaneous and delayed treatment approaches result in favourable final outcomes and are associated with a comparable level of patient satisfaction. Simultaneous EVLA with FS may be offered to patients seeking rapid clinical improvement, whereas a delayed strategy is justified in those accepting longer treatment to reduce sclerotherapy-related complications.
Wołkowski et al. (Fri,) studied this question.