Surgery versus Ultrasound-Guided Foam Sclerotherapy for the Treatment of Isolated Anterior Saphenous Vein Incompetence: A Single-Center Randomized Trial

Background: Isolated anterior saphenous vein (ASV) incompetence is a clinically relevant source of symptomatic anterior thigh varicose veins, which may cause pain, heaviness, swelling and serious complication such as superficial vein thrombosis. Therefore, targeted management is often required, yet evidence guiding treatment remains limited. This single-center, randomized trial compared high ligation surgery in combination with phlebectomy and ultrasound-guided foam sclerotherapy (UGFS). Methods: Thirty-nine limbs of 35 patients (19 allocated to surgery, 20 to UGFS) were treated and followed up at 1 and 3 years. The primary outcome was ASV-territory recurrence defined as reflux time > 0.5 s along the ASV in the UGFS group or new anterior thigh varicosities connected to the previous saphenofemoral junction in the surgical group at 3 years. Secondary outcomes were the same duplex endpoint at 1 year, recurrence of clinically visible varicose veins, and groin neovascularization at 1 and 3 years. Results: ASV-territory recurrence was numerically higher after UGFS (63% vs. 33%) at 3 years, although the difference was not statistically significant, whereas recurrence was higher after UGFS than surgery at 1 year (65% vs. 11%; p < 0.001). Clinical recurrence rates did not differ significantly between groups at 1 and 3 years. Neovascularization was observed exclusively in the surgery group at 1 year and remained more frequent at 3 years (44% vs. 5%). Conclusions: Our findings suggest better short-term disease control with surgery than with UGFS for isolated ASV incompetence, whereas the prespecified primary endpoint of ASV-territory recurrence at 3-years did not differ significantly between groups. Both surgery and UGFS may therefore be considered for selected patients, with treatment choice guided by patient-centered factors, including vein anatomy, invasiveness, and patient preference.