Conventional Vein Stripping and Ligation Surgery 

Vein stripping and ligation surgery have historically been the conventional treatment for addressing reflux in the great saphenous vein. This procedure typically involves general anesthesia in a hospital setting and begins with groin surgery to expose and ligate (i.e., tie off) the diseased great saphenous vein (GSV) and the surrounding tributary veins. Next, a stripping tool is inserted at the groin, threaded through the GSV along the length of the thigh and out through the skin just below the knee. The top of the GSV is then tied to the stripping tool, which is pulled from below the knee to remove the vein from the body. There are several variations of vein stripping.

Although vein stripping effectively treats saphenous vein reflux, the surgery can be traumatic. Recuperation may require up to 6 weeks before patients resume normal activities and return to work. Other primary drawbacks of vein stripping include significant bruising of the thigh and temporary discoloration of the skin as well as potential nerve injury.

Endovenous Laser Ablation (EVLA)

Endovenous laser ablation (EVLA) is a minimally invasive procedure that utilizes an optical diode laser fiber that delivers laser energy to effectively burn the inside of the saphenous vein. The laser energy heat damages the vein wall, thereby creating an inflammatory reaction leading to closure of the targeted vein. The laser fiber is withdrawn while laser energy is delivered, inducing thermal damage. This technique of vein closure can result in significant pain post procedure. Tenderness and bruising persist for up to 3 weeks post procedure. The technique requires the use of tumescent anesthesia which is a dilute lidocaine solution introduced around the targeted vein by a series of needle punctures, this creates a thermal barrier to minimize damage to surrounding tissue from the heat of the laser. EVLA requires the patient to wear compression hose post procedure for up to 3 weeks to assist in the closure process.

Radio Frequency Ablation (RF)

Radiofrequency (RF) ablation is an alternative to EVLA for great and small saphenous veins that are the source of symptomatic varicose veins. RF ablation treats the vein by heating it, causing the vein to contract and then close. This treatment modality has become a widely accepted procedure with good success and low complication rates. To perform the RF ablation procedure, a radiofrequency catheter is placed through a sheath and advanced to the upper end of the diseased vein. Local anesthesia (tumescent) is then delivered to the entire vein by a series of needle punctures. The catheter then heats the inside of the vein as it is slowly withdrawn back down the vein in a systematic fashion. Typical side effects of the RF ablation procedure include, but are not limited to, post procedure pain and bruising. RF ablation requires the patient to wear compression hose for up to 3 weeks post procedure to facilitate the vein closure process.

Sclerotherapy

Foam sclerotherapy is another method for treating venous reflux disease. A sclerosing solution is mixed with air to produce foam and injected directly into the vein. The sclerosing agent causes irritation to the inner lining of the vein wall, resulting in swelling and closure of the vein. Compression hose must be worn for up to 3 weeks after foam sclerotherapy to assist in closure of the vein. One of the problems with this method is that it often does not yield 100% GSV closure and is limited by vein size. Superficial thrombophlebitis (clots) is more common with this method when compared to EVLA or Radiofrequency ablation.

Complications From Endothermal Venous Ablation

Mark H. Meissner M.D.
Percutaneous endothermal ablation of the saphenous veins, using either radiofrequency (RF) or laser energy, has become a widely accepted alternative to stripping. Initial success rates of up to 95% have been associated with less post-operative pain, a more rapid return to work and usual activities, and an objectively improved quality of life early after the procedure. http://www.veithsymposium.org/pdf/vei/3582.pdf