Endovascular Thermal Ablation Technologies for Treatment of Varicose Veins

Abstract

The “gold standard” for the treatment of insufficient saphenous veins has been ligation plus stripping for the past 100 years. This situation has changed in the last decade with the introduction of endovenous thermal ablation techniques. EVTA techniques are always performed under duplex guidance and are proving to be very effective with high success rates at short-term follow-up. As the effectiveness of current EVTA treatments is excellent (>90%), side-effects are mild, and serious complications rare, any new EVTA Procedure should at least perform equally or preferably have some advantages over existing techniques. The hypothesis is that EVSA will be at least as effective as EVLA or RFA. The advantages of steam over the other ablation procedures may be better patient tolerance; a safer, faster and easier procedure; lower costs; and ease of use for perforator veins and ributaries. Future studies should compare the different endovenous treatments in terms of effectiveness and patient-reported outcomes. Further work is also required to try to answer the remaining questions about the exact working mechanism of the different EVTA treatments. In an era of health technology assessment and cost-effectiveness analyses, treatment-related costs will become increasingly important and this will remain a crucial issue in the future.