What are the procedures to treat varicose veins?

From the Guidelines

Varicose veins can be effectively treated with endovenous thermal ablation, which is recommended as the first-line treatment for nonpregnant patients with symptomatic varicose veins and documented valvular reflux, as it offers improved early quality of life and reduced hospital recovery compared to surgical ligation and stripping 1. The most common options for treating varicose veins include:

• Endovenous laser treatment (EVLT) or radiofrequency ablation, which use heat to seal affected veins
• Sclerotherapy, where a solution is injected into the veins causing them to scar and close
• Ambulatory phlebectomy, involving small incisions to remove veins near the surface
• Vein stripping and ligation for more severe cases, though this is less common now Minimally invasive procedures like EVLT and sclerotherapy are typically performed as outpatient treatments with local anesthesia and require minimal recovery time, usually allowing patients to resume normal activities within 1-2 days 1. Some key points to consider when choosing a treatment option include:
• The size and location of the varicose veins, with smaller veins typically treated with sclerotherapy and larger ones with laser or radiofrequency treatments
• The presence or absence of deep venous insufficiency and the characteristics of the affected veins
• The patient's symptoms, preferences, and medical history
• The potential risks and benefits of each treatment option, including the risk of nerve damage, bleeding, and wound infection Compression stockings are often recommended for 1-2 weeks following any procedure to promote healing and reduce swelling 1. It's worth noting that endovenous thermal ablation has been shown to have similar efficacy to surgical ligation and stripping, but with improved early quality of life and reduced hospital recovery 1. Overall, the choice of treatment for varicose veins should be individualized based on the patient's specific needs and circumstances, and should take into account the latest evidence and guidelines in the field.

From the Research

Treatment Options for Varicose Veins

• Varicose veins can be treated with various methods, including minimally invasive therapies such as endovenous laser therapy, radiofrequency ablation, and foam sclerotherapy, as well as conventional surgery (ligation and stripping) 2, 3.
• The choice of treatment depends on the severity of the condition, the presence of saphenofemoral incompetence (SFI) or saphenopopliteal incompetence (SPI), and the patient's preferences and expectations 4, 5.

Minimally Invasive Therapies

• Endovenous laser therapy (EVLT) has been shown to be effective in treating varicose veins, with good long-term results and low complication rates 3, 6.
• Radiofrequency ablation (RFA) is another minimally invasive option, which can be combined with adjunct sclerotherapy for residual varicosities 6.
• Foam sclerotherapy is a minimally invasive treatment that can be used alone or in combination with other treatments, but it may have a higher recurrence rate in patients with SFI or SPI 3, 4.

Conventional Surgery

• High saphenous ligation and sclerotherapy can be an effective combination for treating varicose veins, especially in patients with SFI or SPI 4.
• Conventional surgery (ligation and stripping) is still a viable option, but it may have higher risks and costs compared to minimally invasive therapies 2, 3.

Patient Preferences and Expectations

• Patients with varicose veins often have limited knowledge of available treatments and may rely on their vascular surgeon's opinion when making a treatment decision 5.
• Many patients prefer local anaesthetic treatment and a single visit treatment, but may not be aware of all the available options 5.