Chronic venous insufficiency resulting from great saphenous vein (GSV) reflux is a problem seen with increasing frequency in most vascular surgical practices. Traditionally treated with high ligation and stripping, minimally invasive techniques for ablation of the GSV have evolved. These include endovenous laser surgery, radiofrequency ablation, and foam sclerotherapy. The authors discuss the mechanism of action of each modality, as well as the techniques for intervention, outcomes, and complications. Minimally invasive treatment of venous insufficiency is efficacious, with less morbidity than high ligation and stripping, allowing for successful treatment and improved patient satisfaction.
Callman MJEpidemiology of varicose veins. Br J Surg. 1994;81:167-173.
2.
Labropoulos N., Giannoukas AD, Delis K., et al. Where does venous reflux start? J Vasc Surg. 1997;26:736-742.
3.
Sarin S., Scurr JH, Coleridge-Smith PDStripping of the long saphenous vein in the treatment of primary varicose veins. Br J Surg. 1994;81:1455-1458.
4.
Johnson CM, McLafferty RBEndovenous laser ablation of varicose veins: review of current technologies and clinical outcome. Vascular. 2007;15:729-736.
5.
Roggan A., Friebel M., Dorschel K., et al. Optical properties of circulating human blood in the wavelength range 400-2500 nm. J Biomed Opt. 1999;4:36-46.
6.
Proebstle T. , Gul D., Kargle A., Knop J.Endovenous laser treatment of the greater saphenous vein with a 940 nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser generated steam bubbles. J Vasc Surg . 2002;35:729-736.
7.
Kabnick LSOutcome of different endovenous laser wavelengths for great saphenous vein ablation. J Vasc Surg.2006;43:88.e1-88.e7.
8.
Navarro L., Min R., Boné C.Endovenous laser: a new minimally invasive method of treatment for varicose veins- preliminary observations using an 810 nm diode laser. Dermatol Surg. 2001;27:118-122.
9.
Proebstle T. , Gul D., Kargl A., Knop J.Endovenous laser treatment of the lesser saphenous vein with a 940-nm diode laser: early results. Dermatol Surg . 2003;29:357-361.
10.
Min RJ, Khilnanie N., Zimmet SEEndovenous treatment of saphenous vein reflux: long-term results. J Vasc Interv Radiol. 2003;14:991-996.
11.
Marston WA, Owens LV, Davies S., Mendes RR, Farber MA, Keagy BAEndovenous saphenous ablation corrects the hemodynamic abnormality in patients with CEAP clinical class 3-6 CVI due to superficial reflux. Vasc Endovasc Surg. 2006;40:125-130.
12.
Mozes G., Kalra M., Carmo M., Swenson L., Gloviczki P.Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques. J Vasc Surg. 2005;41:130-135.
13.
Fernandez CF, Roizental M., Carvallo J.Combined endovenous laser therapy and microphlebectomy in the treatment of varicose veins: efficacy and complications of a large single-center experience . J Vasc Surg. 2008;48:947-952.
14.
Timperman PE , Sichlau M., Ryu RKGreater energy delivery improves treatment success of endovenous laser treatment of incompetent saphenous veins. J Vasc Interv Radiol. 2004;15:1061-1063.
15.
Zimmet SE, Min RJTemperature changes in perivenous tissue during endovenous laser treatment in a swine model. J Vasc Interv Radiol. 2003 ;14:911-915.
16.
Pichot O., Kabnick LS, Creton D., Merchant RF, Schuller-Petroviae S., Chandler JGDuplex ultrasound scan findings two years after great saphenous vein radiofrequency endovenous obliteration. J Vasc Surg. 2004 ;39:189-195.
17.
Zikorous AW , Mirizzi MSEvaluation of setpoint temperature and pullback speed on vein adventitial temperature during endovenous radiofrequency energy delivery in an in vitro model. Vasc Endovasc Surg. 2004;38:167-174.
18.
Lumsden AB, Peden EKClinical use of the new ClosureFAST radiofrequency catheter. Endovasc Today. 2007;(suppl):7-10.
19.
Merchant RF, Frisbie JS, Kistner RLEndovenous radiofrequency obliteration of saphenous vein reflux. In: Pearce WH, Matsumura JS, Yao JS, eds. Trends in Vascular Surgery 2006. Evanston, IL: Greenwood Academic; 2007: 429-442.
20.
Merchant RF , Pichot O.; Closure Study Group.Long-term outcomes of endovenous radiofrequency obliteration of saphenous reflux as a treatment for superficial venous insufficiency. J Vasc Surg. 2005;42:502-509.
21.
Merchant RF , DePalma RG, Kabnick LSEndovascular obliteration of saphenous reflux: a multicenter study. J Vasc Surg. 2002;35:1190-1196.
22.
Weiss RA, Weiss MAControlled radiofrequency endovenous occlusion using a unique radiofrequency catheter under duplex guidance to eliminate saphenous varicose vein reflux: a 2-year follow-up. Dermatol Surg. 2002;28:38-42.
23.
Breux F-X., Guggenbichler S.European Consensus Meeting on Foam Sclerotherapy, April 4-6, 2003, Tegernsee, Germany. Dermatol Surg.2004;30:709-717.
24.
Monfreux A.Traitement sclérosant des troncs saphéniens et leurs collaterals de gros caliber par la method mus [in French]. Phlébologie. 1997;50:351-353.
25.
Tessari L., Cavezzi A., Frullini A.Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg. 2001;27:58-60.
26.
Hamels-Desnos C., Desnos P., Wollman JC, Ouvry P., Mako S., Allaert FAEvaluation of the efficacy of polidocanol in form of foam compared to liquid form in sclerotherapy of the greater saphenous vein: initial results. Dermatol Surg. 2003 ;29:1170-1175.
27.
Bountouroglou DG, Azzam M., Kakkos SK, Pathmarajah M., Young P., Geroulakos G.Ultrasound-guided form sclerotherapy combines with sapheno-femoral ligation compared to surgical treatment of varicose veins: early results of a randomised controlled trial. Eur J Vasc Endovasc Surg. 2006;31:93-100.
28.
Guex JJ, Allaert FA, Gillet JL, Chieir F.Immediate and midterm complications of sclerotherapy: report of a prospective multicenter registry of 12,173 sclerotherapy sessions. Dermatol Surg. 2005;31:123-128.
