24424141
OBJECTIVE	To test the hypothesis that patients with soft tissue changes related to superficial venous insufficiency ( SVI ) have greater benefits from treatment than those with only symptomatic varicose veins .
BACKGROUND	A commonly held view is that SVI is only a minor ailment , yet randomized clinical trials ( RCTs ) show that treatment improves quality of life ( QoL ) and is cost-effective .
BACKGROUND	In an effort to curb the treatment costs of this common disorder , rationing is applied in many health care systems , often limiting the reimbursement of treatment to those with soft tissue changes .
METHODS	This cohort study draws its data from an interventional RCT .
METHODS	After informed consent , consecutive patients with symptomatic unilateral SVI were randomized to receive surgical ligation and stripping or endovenous laser ablation .
METHODS	This analysis differentially studies the outcomes of patients with simple varicose veins ( C2 : n = 191 ) and soft tissue complications ( C3-4 : n = 76 ) .
METHODS	Effectiveness outcomes measured up to 1 year included the following : Qol [ short form 36 ( SF36 ) , EuroQol , and the Aberdeen Varicose Veins Questionnaire ] , clinical recurrence , and the need for secondary procedures .
METHODS	Multivariable regression analysis was used to control for potential confounding factors .
RESULTS	Both groups saw significant improvements in QoL .
RESULTS	All improvements were equal between groups apart from the SF36 domain of Bodily Pain , where C2 saw an improvement of 12.8 [ 95 % confidence interval ( CI ) : 4.8-20 .8 ] points over C3-4 participants ( P = 0.002 ) , who also suffered more recurrence [ odds ratio ( OR ) = 2.7 , 95 % CI : 1.2-6 .1 , P = 0.022 ] and required more secondary procedures ( OR = 4.4 , 95 % CI : 1.2-16 .3 , P = 0.028 ) .
CONCLUSIONS	This study suggests that rationing by clinical severity contradicts the evidence .
CONCLUSIONS	Delaying treatment until the development of skin damage leads to a degree of irreversible morbidity and greater recurrence .
BACKGROUND	NCT00759434 Clinicaltrials.gov .

