Minimally invasive techniques
Treating varicose veins without surgery
Today most varicose veins can be treated without a conventional operating theatre, without a hospital stay and without prolonged time off work. Endovenous techniques and sclerotherapy have replaced conventional surgery as the first choice in the European guidelines.
The options
RadiofrequencyCloses the saphenous vein with heat from the inside. In the European ClosureFast study, the vein remained closed at 5 years in 91.9% of cases.
VenaSealSeals the vein with medical adhesive, without heat. In the VeClose trial, 91.4% closure at 5 years, non-inferior to radiofrequency.
Foam sclerotherapyInjection of a drug that closes the vein. Useful for branch veins, small and medium-sized varicose veins and recurrences.
Transdermal laserFor very fine spider veins, with no needles.
Which technique is right?
It depends on which vein is failing, its size and course, the symptoms and the patient’s preferences. That is why everything starts with a venous duplex ultrasound in clinic. The 2022 European guideline recommends thermal ablation (radiofrequency or endovenous laser) as the first choice for saphenous reflux, considers non-thermal techniques as an alternative, and foam or phlebectomy for branch varicose veins. I often combine several techniques in the same leg.
Advantages over conventional surgery
- Local anaesthesia, no hospital stay.
- Less pain and bruising than stripping.
- Quick return to activity.
- Comparable long-term results.
Limitations
No technique cures the tendency to develop varicose veins: new ones may appear over the years, which can usually also be treated without surgery. Keeping a healthy weight, walking and avoiding standing still for long periods all help.
Videos on this topic (in Spanish)
References
- De Maeseneer MG, Kakkos SK, Aherne T, et al. European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184-267.
- Proebstle TM, Alm BJ, Göckeritz O, et al. Five-year results from the prospective European multicentre cohort study on radiofrequency segmental thermal ablation for incompetent great saphenous veins. Br J Surg. 2015;102(3):212-218.
- Morrison N, Gibson K, Vasquez M, et al. Five-year extension study of patients from a randomized clinical trial (VeClose) comparing cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord. 2020;8(6):978-989.
- Rabe E, Breu FX, Cavezzi A, et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2014;29(6):338-354.
Patient information reviewed by Dr Óscar Merino, vascular surgeon. It does not replace an individual medical assessment.
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Consultation with duplex ultrasound at Clínica Rotger, in the centre of Palma.
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