- Thermal ablation and destruction with involution and closure of the varicose vein using a heating element to perform the vein ablation—this technique includes radiofrequency vein ablation using a catheter derived heating element to produce the heat or a laser light that generates the heating effect that denatures the vein wall elements using heat and then results in fibrosis shrinkage and closure of the vein—a great variety of differing laser catheters are available that use varying wavelengths and fiber types to achieve their effects. All thermal techniques require the administration of a tumescent anesthetic solution around the vein and local anesthesia through a series of injections and do carry the risk of some postoperative pain, bruising, deep vein thrombus formation, and damage to nerves where these nerves course close to the vein being ablated typically below the knee. Heat generated at temperatures greater than 120 degrees Celsius is buffered by injection of local anesthesia and tumescent solution around the vein. This fluid acts to anesthetize the vein and acts as a heat sink to prevent heat damage to surrounding tissues. This tumescent fluid injection while not extremely painful, does require injections of local anesthesia and has some discomfort of distension associated postoperatively with it and requires the postoperative use of compressive dressings/stockings also for best effect. These techniques are very successful, have largely replaced surgical vein stripping and carry excellent long term and short-term success rates and have been proven to be safe and efficacious in many countries over the last two decades. High early success rates are seen with a very low subsequent recurrence rate up to 10 years after treatment. Overall efficacy and lower morbidity have resulted in endovenous ablation techniques replacing surgical stripping. Patient satisfaction is high and downtime is minimal, with 95% of patients reporting they would recommend the procedure to a friend. At 5-year follow-up, thermal ablation techniques such as radiofrequency and laser ablatio remain a successful treatment for over 90% of patients with incompetent great saphenous veins.
- Sclerotherapy is the treatment of choice for smaller veins such as telangiectasias and reticular veins. It is also commonly used as an accompanying and additive treatment for tributaries of the main saphenous vein after obliteration by endovenous laser, radiofrequency, or surgery. Sclerotherapy is endovenous chemical ablation performed using a variety of agents. These include detergents, chemical irritants and osmotic type agents. They generally serve to disrupt cell wall membranes and cause cell damage in the vessel wall that results in thrombosis, destruction, scarring and long-term shrinkage. Sclerotherapy can also be used as a primary treatment for varicosities and saphenous veins, is commonly injected into the vein using either the naked eye or also using ultrasound assistance. The results for large truncal vein (saphenous large vein) closure are inferior in the long term to laser/radiofrequency or other thermal methods of vein closure.