Minimally invasive management of varicose veins: Bridging the gap between traditional and modern methods

Abstract

Objectives

Chronic venous disease (CVD) commonly presents as varicose veins, affecting a significant proportion of the population. Current treatments vary from invasive surgeries to advanced minimally invasive techniques, but many involve high costs and risk of complications. This study aimed to introduce and evaluate a novel, cost-effective technique combining high ligation of the great saphenous vein (GSV) with foam sclerotherapy, designed to minimize invasiveness, reduce complications, and improve patient outcomes.

Methods

The procedure began with ultrasound-guided mapping and marking of the GSV and perforating veins. Under local anesthesia, two small micro-incisions were created on the medial side of the leg. A double ligation was performed at the saphenofemoral junction using a 2-0 PDS suture, ensuring complete vein closure. Subsequently, the angiocatheters were inserted into the GSV above the perforators or in the mid-section of the vein if no perforators were present. Foam sclerotherapy was administered using a mixture of sodium tetradecyl sulfate, normal saline, and air. Compression bandaging was applied from the lower leg upward postoperatively. 18 patients were treated with this technique and followed up at 2 weeks, 3 months, and 6 months to assess clinical outcomes, complications, and recurrence.

Results and Conclusions

The novel technique demonstrated satisfied clinical outcomes with no reported complications, such as ecchymosis, hematoma, or discomfort, at the 2-week follow-up. No deep vein thrombosis (DVT) or recurrence cases were observed at the 3- and 6-month follow-ups. Our method reduced postoperative discomfort, bruising, and recovery time compared to traditional high ligation with stripping. Patients reported high satisfaction due to the minimally invasive nature and improved cosmetic results. Compared to thermal ablation methods, the technique was similarly effective but offered notable advantages in cost-effectiveness and accessibility, as it eliminated the need for expensive equipment or anesthesia. Future studies with larger sample sizes and extended follow-up periods are needed to validate these findings further, explore long-term recurrence rates, and refine patient selection criteria. This approach represents a promising, practical alternative for varicose vein treatment in diverse clinical settings.