Lower extremity varicose vein disease is most often associated with truncal venous insufficiency involving the saphenous system: the great saphenous vein, the small saphenous vein, and/or incompetent major tributaries or perforator veins. Management of varicose vein disease has historically been treated with stripping of the saphenous vein, and interruption/ligation and removal of the major tributary and perforator veins. Since 1999, endovenous ablation procedures have been reported to be safe and effective methods of eliminating the proximal portion of the great saphenous vein, the small saphenous vein, and even tributary and perforator veins from the venous circulation, with faster recovery and better cosmetic results than stripping. The three currently available methods used to achieve ablation of these diseased veins are: the Closure procedure using a radiofrequency (RF) catheter and generator (VNUS Medical Technologies, Inc, San Jose, California); the endovenous laser ablation procedure using a laser fiber and generator (various manufacturers); and endovenous chemical ablation with ultrasound guided foam sclerotherapy (either catheter-directed or injection). The first two systems use electromagnetic energy while the latter utilizes a foamed chemical detergent (Polidocanol or sodium tetradecylsulfate). As with a stripping procedure, following these endovenous ablation procedures it is necessary to treat any remaining portion of the great and/or small saphenous vein, perforator veins, and varicose tributaries additionally, typically with either sclerotherapy and/or phlebectomy.
Written By Nick Morrison MD, FACPh
Posted By Kelly Lorenzen