ABSTRACT
This chapter incorporates recommendations from the European Society for Vascular Surgery, Society for Vascular Surgery, and American Venous Forum. Endovenous thermal ablation (ETA) can be performed under general anaesthesia, spinal anaesthesia or femoral nerve block, but tumescent anaesthesia is the preferred technique as it allows early ambulation. The most frequent sites for recurrence after ETA of the great saphenous vein are recanalization and development of anterior thigh vein reflux. A multicentre American study of 222 patients with great saphenous reflux randomized to cyanoacrylate closure or Radio frequency (RF) showed that the Cyanoacrylate closure (CAC) technique was non-inferior to RF at three months and that both showed good safety profiles. Mechanical Occlusion Chemically Assisted (MOCA) is designed to introduce a sclerosant solution into a target vein for infusion through a catheter, with sclerosant action on the intima enhanced by a rapidly-rotating wire to disperse the infused fluid and to damage the vessel wall.
