{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T02:03:34Z","timestamp":1791165814675,"version":"4.1.0"},"reference-count":19,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Phlebology"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The optimal timing of tributary treatment in varicose vein management remains debated. Concomitant endovenous therapy may reduce the need for subsequent procedures and accelerate recovery, whereas a staged approach may spare some patients unnecessary interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the efficacy, effectiveness, and safety of combined endovenous therapy with phlebectomy or foam sclerotherapy compared to endovenous therapy alone for lower limb varicose veins.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing concomitant combined endovenous therapy (ablation with immediate phlebectomy or foam sclerotherapy) versus ablation alone. The primary outcome was re-intervention. Secondary outcomes included clinical improvement (VCSS and AVVQ), postoperative complications, pain, and serious adverse events. Data were pooled using random-effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six RCTs involving 432 patients were included. Combined endovenous therapy significantly reduced re-intervention rates (RR = 0.33, 95% CI: 0.18\u20130.62) compared with ablation alone. Combined endovenous treatment also provided superior short-term improvement in quality of life (AVVQ at 6 weeks: MD = 5.24, 95% CI: 2.53\u20137.94) and longer-term clinical severity (VCSS at 12 months: MD = 0.86, 95% CI: 0.40\u20131.31). There were no significant differences in superficial thrombophlebitis, nerve-related events, postoperative pain, or serious adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Combined endovenous therapy offers greater efficacy and effectiveness than endovenous therapy alone, reducing re-intervention and improving both short- and longer-term outcomes without compromising safety. Staged treatment may remain reasonable for selected patients, but from a patient-centered perspective, additional procedures represent a treatment burden. Most patients are likely to see better outcomes from combined endovenous therapy with phlebectomy or foam sclerotherapy compared to endovenous therapy alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02683555261443824","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T20:49:34Z","timestamp":1776372574000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Combined endovenous ablation with phlebectomy or foam sclerotherapy versus endovenous ablation alone for lower limb varicose veins: A systematic review and meta-analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5415-4504","authenticated-orcid":false,"given":"Yu","family":"Xie","sequence":"first","affiliation":[{"name":"Chengdu University of Traditional Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihong","family":"Cui","sequence":"additional","affiliation":[{"name":"Guangzhou University of Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caijuan","family":"Geng","sequence":"additional","affiliation":[{"name":"Hospital of Chengdu University of Traditional Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zeng","sequence":"additional","affiliation":[{"name":"Hospital of Chengdu University of Traditional Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4547-8676","authenticated-orcid":false,"given":"Yao","family":"Lin","sequence":"additional","affiliation":[{"name":"Hospital of Chengdu University of Traditional Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3640-2576","authenticated-orcid":false,"given":"Lifeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Hospital of Chengdu University of Traditional Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0623-5882","authenticated-orcid":false,"given":"Chunshui","family":"He","sequence":"additional","affiliation":[{"name":"Hospital of Chengdu University of Traditional Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvsv.2023.08.011"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvsv.2021.08.011"},{"issue":"8","key":"e_1_3_6_4_2","first-page":"CD005624","article-title":"Interventions for great saphenous vein incompetence","volume":"8","author":"Whing J","year":"2021","unstructured":"Whing J, Nandhra S, Nesbitt C, et al. 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Cochrane Database Syst Rev 2021; 8(8): CD005624. https:\/\/doi.org\/10.1002\/14651858.CD005624.pub4","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/1531003506297364"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2020.05.028"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1308\/003588414X13814021679474"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvsv.2017.10.012"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.934475"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-135"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-023-02217-1"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.6556"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9565"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000790"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvsv.2025.102255"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/02683555241276709"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2008.01.062"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znac388"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2008.06.030"}],"container-title":["Phlebology: The Journal of Venous Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02683555261443824","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02683555261443824","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02683555261443824","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T17:56:45Z","timestamp":1777658205000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02683555261443824"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":19,"alternative-id":["10.1177\/02683555261443824"],"URL":"https:\/\/doi.org\/10.1177\/02683555261443824","relation":{},"ISSN":["0268-3555","1758-1125"],"issn-type":[{"value":"0268-3555","type":"print"},{"value":"1758-1125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]},"article-number":"02683555261443824"}}