Comparative Study between Recent Modalities of Treatment of Varicose Veins

Abstract

Chronic venous disorders encompass a spectrum of venous diseases from simple telangiectases (spider veins) and reticular veins,varicose veins, leg edema from dysfunctional venous tone with valve incompetence and abnormal calf muscle pump function, to more severe and advanced forms of venous disorders, including hyperpigmented skin changes, dermalsclerosis, and ulcer formation. Part of the spectrum of chronic venous disordersincludes varicose veins, edema, and skin changes and ulcers affecting the lower limb, which are categorized as chronic venous disease (CVD).

CVD is a very common problem, with varicose veins affecting more than 25 million adults in the United States, with more than 6 million having more advanced venous disease. The standard treatment of varicose veins for many years has been surgical ligation and stripping of the affected vein. Although outcomes have improved in recent years because of enhanced understanding of lower extremity venous anatomy, the failure rate with this approach is frequently reported to be between 20% and 30%.

In addition, surgical ligation and stripping are invasive, usually requiring general anesthesia and several weeks’ recovery before return to normal activities. In response to the need for a less invasive approach, numerous endovenous treatments have emerged over the past several years. The most notable endovenous advancements are the now widespread techniques of radiofrequency ablation (RFA) and endovenous laser ablation (ELA). These methods have demonstrated clinical superiority to stripping and surgical ligation as well as significantly less postoperative pain and recovery time. Ultrasound guided foam sclerotherapy (UGFS) is a popular treatment option for varicose veins. A recent survey of members of The Vascular Society of Great Britain and Ireland and the Venous Forum of the Royal Society of Medicine revealed that UGFS was offered to National Health Service (NHS) patients by 27% of surgeons. Sclerotherapy is best defined as the introduction of a chemical into the lumen of a vein to induce endothelial damage that results in thrombosis and eventually fibrosis. Considered the most versatile treatment option for venous ablation, sclerotherapy can be used to treat a large range of vein sizes from telangiectasias to large varicose veins. With the advent of the radiofrequency and endovenous laser procedures, the primary intent of sclerotherapy is to effectively eliminate the target vein after the highest point of reflux is treated.