Endovascular solutions for varicose vein disease

Over the last decade many endovenous techniques have been developed for the treatment of superficial venous insufficiency, in order to improve the side-effect profile of superficial venous surgery, shorten recovery times and increase durability. This review outlines the available techniques, focussing mainly on endovenous laser ablation, radiofrequency ablation and ultrasound-guided foam sclerotherapy. The evidence for the different techniques is discussed, including technical (anatomical) success in the short- and long-term; changes in clinical status (including symptom relief and cosmesis); improvements in health-related quality of life; patient satisfaction; and cost, both in terms of time away from normal activities and direct cost of treatment as measured in cost-effectiveness analyses. The side-effects and complications of the various techniques are discussed. While most available data focus on primary great saphenous treatment; the evidence for treatment of recurrent VV and small saphenous varicose veins is also discussed.