The introduction of the minimally invasive, endovenous thermal techniques of superficial reflux ablation have revolutionized the treatment of varicose veins in the last 8 years. The ease of performance even in an office setting, reduced discomfort, and quicker return to normal activity have resulted in universally superior patient acceptance and have made these endovenous procedures the mainstay of present treatment of varicose veins. With encouraging early and mid-term results, future developments in this field must mandate standardization of technical aspects, follow-up imaging, and reporting. The significance of reflux in the great saphenous vein stump, of reflux-free recanalization of a segment of the vein, and their potential for causing recurrent varicose veins remains unknown. The incidence of groin neovascularization and its significance needs to be determined. Ultrasound-guided foam sclerotherapy is also emerging as a competitor to other endovenous techniques and is particularly useful in superficial and tortuous veins not ideally suited for endovenous thermal ablation, as well as recanalized segments of ablated veins.
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