ABSTRACT
This chapter includes recommendations from the European Society for Vascular Surgery, Cochrane Database, NICE Guidelines, Society for Vascular Surgery and American Venous Forum. These include: conservative management, superficial cosmetic procedures, direct-vision sclerotherapy, catheter-directed sclerotherapy, steam ablation, and surgery. Sclerotherapy techniques can be collectively referred to as chemical ablation and are performed using either liquid or foamed sclerosant. Endovenous laser ablation (EVLA), radio-frequency ablation (RF) and steam ablation are collectively termed endovenous thermal ablation (ETA). EVLA and RF are used to ablate saphenous veins and incompetent perforators, while EVLA is also used for relatively straight tributaries and arteriovenous malformations. Steam ablation promises to allow both saphenous veins and tributaries to be controlled. Cyanoacrylate embolisation avoids the need for tumescent anaesthesia. ETA shows faster recovery and return to work and normal activities, higher patient satisfaction, less pain and better short-term quality of life than traditional surgery, with comparable efficacy for eliminating venous reflux and relieving symptoms for both.
