Vein Stripping Surgery

Vein stripping surgery is a common treatment for venous reflux in the great saphenous vein. The procedure requires general anaesthesia in a hospital setting, and can be very invasive. Incisions are made along the leg so that the diseased veins are exposed and can be ligated (tied off). If the vein needs to be stripped, the physician will thread a stripping tool through the vein and then pull the entire vein from the leg. Although this procedure effectively treats saphenous vein reflux, the surgery can be traumatic. It may take up to six weeks before patients can get back to normal activities and return to work. Leg pain is the most common side effect, but other drawbacks include major bruising of the thigh and temporary discoloration of the skin, as well as potential nerve damage.

Endovenous Laser Ablation (EVLA)

Endovenous laser ablation (EVLA) is a minimally invasive procedure that uses a probe to deliver laser energy to the inside of the great saphenous vein. The heat from the laser burns and destroys the vein walls, causing an inflammatory reaction. As a result, the diseased vein closes. This technique uses high heat and can sometimes cause tissue or nerve damage beyond the diseased vein. This can lead to significant pain after the procedure. Tenderness and bruising can last for up to three weeks. Laser ablation requires multiple needle sticks along the length of the leg so that tumescent anaesthesia can be injected into the vein. The goal of the anaesthesia is to minimize thermal damage by creating a barrier between the surrounding tissue and the heat of the laser. EVLA requires the patient to wear compression hose after the treatment for up to three weeks to help with the closure process.

Radiofrequency Ablation (RF)

Radiofrequency (RF) ablation is an alternative to EVLA for great and small saphenous veins. Using a different kind of thermal energy to treat the vein, RF ablation causes the vein to contract and then close. To perform the RF ablation procedure, a radiofrequency catheter is inserted into the uppermost part of the vein. Next, tumescent anaesthesia is delivered to the entire vein by a series of needle injections along the leg. The catheter then heats the inside of the vein as it is slowly pulled all the way back. Ordinary 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 three weeks after treatment to help the vein closure process.

Sclerotherapy

Foam sclerotherapy is another treatment for venous reflux disease. A sclerosing solution is mixed with air to produce foam and injected directly into the vein. The sclerosing solution causes irritation to the inner lining of the vein wall, leading to swelling and closure of the vein. Compression hose must be worn for up to three weeks after foam sclerotherapy to help with closure of the vein. Some find this method problematic because it often does not yield good closure results, is limited by vein size, and may require multiple treatments. Blood clots (superficial thrombophlebitis) are more common with this treatment when compared to EVLA or radiofrequency ablation.