Endoluminal treatments for varicose veins

Abstract 

Superficial chronic venous insufficiency affects 10–25% of the UK population. There is a wide spectrum in its effects ranging from asymptomatic varices, those giving symptoms of venous congestion, skin changes including venous eczema, lipodermatosclerosis and venous ulceration with its associated costs to the health service.

Treatments include lifestyle changes and compression hosiery with surgery offered to those with significant symptoms or complications related to venous insufficiency.

Traditional surgery involves disconnection of the superficial and deep venous systems, and stripping of the truncal vein often combined with phlebectomy.

Endoluminal treatments for varicose veins have existed since the 1950s in the form of liquid sclerotherapy. Its combination with air in the 1990s allowed foam sclerotherapy to be used in the treatment of truncal venous reflux.

Over the last 10 years endothermal techniques have been developed to treat incompetent truncal veins using either laser or high-frequency radio waves to ablate the vein.

All three treatments can be performed under local anaesthesia in a consulting room or outpatient department with appropriate facilities. This has a potential cost saving to the health service.

The principles and practice of the three techniques are described.

Keywords: Ablation, endothermal, endovenous, EVLA, laser, radiofrequency ablation, sclerotherapy, UGFS, venous