Reviewed for medical accuracy by Dr Evelyne Jonniaux, Medical Advisor
Last updated 17 September 2026
On recurrence at five years, no varicose vein technique has demonstrated superiority. What is established comes to three points: foam is technically inferior, laser causes fewer immediate complications, and endovenous techniques get people back to activity a few days sooner. Open surgery is not disqualified by the data.
The questions we get asked
Which technique gives the fewest recurrences?
The Cochrane review finds no difference between laser and open surgery at five years, at moderate certainty. The signals favouring radiofrequency each rest on a single trial, at low certainty. And the Danish trial that compared all four techniques finds an excess of recurrence after laser, 38.6 percent, which its own authors state is unexplained and needs confirmation.
We report it as it stands, because that is the real state of the question.
Is foam an option?
It is the only robust and consistent gap in the evidence, and it runs against foam. The large British trial finds occlusion of the saphenous trunk markedly rarer after foam. The Danish trial gives 31.5 percent recanalisation at five years against 6 to 7 percent for the other techniques. Cochrane confirms surgery’s technical superiority beyond five years.
Oddly, it is nonetheless foam that gets people back to full-time work fastest in the British trial, ahead of laser.
How much time off should be expected?
Less than is claimed, and the gap between techniques is small. The Danish trial measures a median 2.9 days off work after radiofrequency and after foam, 3.6 days after laser, 4.3 days after open surgery. The difference is counted in days, not weeks.
Is open surgery obsolete?
No, and this is counter-intuitive. At five years the British trial gives surgery a disease-specific quality of life score equivalent to laser, and better than foam. Cochrane finds no difference in recurrence between laser and surgery. And the Danish trial performed all four techniques, surgery included, under tumescent local anaesthesia with light sedation.
What about glue and mechanochemical techniques?
Nothing is demonstrated. The available comparisons give unmanageable confidence intervals, from 0.06 to 54 for technical success, and Cochrane notes that long-term data do not exist.
What the figures say
| Finding | Figure | Source |
|---|---|---|
| Complications at 6 months | laser 1, foam 6, surgery 7 percent | CLASS trial, N Engl J Med, 2014 |
| Recanalisation at 5 years | foam 31.5 percent, others 6 to 7 | Rasmussen et al., Int Angiol, 2017 |
| Clinical recurrence at 5 years | 18.7 to 38.6 percent by technique | Rasmussen et al., 2017 |
| Laser against surgery, recurrence at 5 years | no difference, moderate certainty | Cochrane, 2021 |
| Median time off work | 2.9 to 4.3 days by technique | Rasmussen et al., Br J Surg, 2011 |
| Generic quality of life at 5 years | no difference between the three techniques | CLASS, N Engl J Med, 2019 |
Three widespread figures we could not source. “20 to 30 percent recurrence at five years whatever the technique”: no pooled estimate exists, Cochrane could not aggregate that outcome. “Back to work in one to two days after laser”: the published measure is 3.6 days, and laser is not the fastest-return technique. And “95 to 98 percent laser success” conflates clinical success with anatomical occlusion.
What Noria Health does, and does not do
We organise a vascular surgery consultation with a specialist team near Brussels, venous duplex ultrasound included, and confirm feasibility within 24 to 48 hours. Follow-up is documented at D14, D30 and D90.
We do not choose the technique for you, we do not assess it from a photograph, and we do not contradict the team following you.
Who reviewed this page
Noria Health editorial team.
See also: all our articles on vascular surgery.
Have your case reviewed. Noria Health arranges a specialist consultation near Brussels and confirms feasibility within 24 to 48 hours. Open a case.