Strategies and challenges in treatment of varicose veins and venous insufficiency

Abstract

Patients with varicose veins can be treated with conservative or surgical approaches based on the clinical conditions and patient preferences. In the recent decade, the recommendations for managing symptomatic varicose veins have changed dramatically due to the rise of minimally invasive endovascular techniques. The literature was systematically searched on Medline without language restrictions. All papers on the treatment of varicose veins and venous insufficiency with different procedures were included and reviewed. Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) both are same safe and effective in terms of occlusion rate, and time to return to normal activity. In comparison with RFA or EVLT, Cure conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire (CHIVA) may cause more bruising and make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury, or hematoma. In terms of recurrence of varicose veins, there is little or no difference between CHIVA and stripping, RFA, or EVLT. Great saphenous vein recanalization is highest in the ultrasound-guided foam sclerotherapy (FS) group (51%) during 1 year of follow-up. The 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as a third-line therapeutic option after EVLA or RFA and sclerotherapy. Although the mechanochemical endovenous ablation (MOCA) is a non-thermal, non-tumescent option and appears to be of similar efficacy to stab avulsion with no potential risk of nerve damage, the overall success rate of MOCA is lower than those of other procedures such as EVLA, RFA, or high ligation and stripping. EVLA is the most cost-effective therapeutic option, with RFA being a close second for the treatment of patients with varicose veins. Endovenous thermal ablation (EVLA or RFA) is recommended as a first-line treatment for varicose veins and has substituted the high ligation of saphenofemoral junctional reflux and stripping of varicose veins. Ultrasound-guided FS is associated with a high recurrence rate and can be used in conjunction with other procedures. MOCA and cyanoacrylate embolization appear promising, but evidence of their effectiveness is required.

ThermoBLOCK® RFA System Effectively and Safely Treats Great Saphenous Vein Reflux

“…Left untreated, GSV reflux can result in serious conditions such as deep vein thrombosis and venous thromboembolism. 2 Minimally invasive endovascular thermal ablation techniques such as endovenous laser ablation and radiofrequency ablation (RFA) have been the first-line treatment options for GSV reflux over the past 2 decades since they require no general anesthesia, accelerate recovery, improve patient quality of life, and avoid certain surgical risks such as ecchymosis, hematoma, and perioperative pain. 3,4 As the CEO of the company manufacturing the ThermoBLOCK ® RFA System (Invamed, Ankara, Turkey), I agree with Beyaz et al's observations about occlusion rate above 96% and the acceptable complication rate.…”

“…Left untreated, GSV reflux can result in serious conditions such as deep vein thrombosis and venous thromboembolism. 2…”

Enhancing patient comfort in varicose vein treatment through combined lidocaine and ropivacaine tumescent anesthesia

“…The composition of tumescent anesthetic solutions varies widely in the current literature, with no standardized criteria. Local anesthetics are the pivotal components of tumescent anesthesia solutions ( 4 ). Lidocaine is a commonly used local anesthetic known for its rapid onset of action.…”

A prognostic nomogram for recurrence survival in post-surgical patients with varicose veins of the lower extremities

“…Notably, there has been a growing interest in minimally invasive techniques and their role in reducing recovery time, minimizing complications, and potentially lowering recurrence rates. Technologies such as endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) have emerged as promising alternatives to traditional surgery, with recent studies highlighting their efficacy and patient satisfaction scores 9 , 10 . Moreover, the role of genetic predisposition and molecular biology in the development and progression of VVLEs is gaining attention 11 , suggesting potential areas for therapeutic intervention and risk assessment.…”