Download the report - KCE
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10 Varicose Veins <strong>KCE</strong> Reports 164<br />
1.5.2 Endovenous Laser Therapy<br />
Endovenous laser <strong>the</strong>rapy (EVLT) is a minimally invasive treatment of varicose veins. The<br />
procedure involves introduction of a laser fibre into <strong>the</strong> lumen of <strong>the</strong> saphenous vein,<br />
followed by <strong>the</strong> application of laser energy which destroys <strong>the</strong> vein wall after local<br />
injection of fluid to cause tumescence around <strong>the</strong> treated vein. The fibre and ca<strong>the</strong>ter<br />
are slowly withdrawn and <strong>the</strong> vein lumen collapses, occluding <strong>the</strong> length of <strong>the</strong> vein and<br />
abolishing venous reflux 33 .<br />
1.5.3 Radiofrequency Ablation<br />
A similar technique to EVLT is radiofrequency ablation (RFA).<br />
A heat-generating ca<strong>the</strong>ter inserted into <strong>the</strong> vein emits radio-frequency wavelengths for<br />
ablation 33 . After tumescent injection, <strong>the</strong> ca<strong>the</strong>ter is heated and slowly withdrawn down<br />
<strong>the</strong> length of <strong>the</strong> vein, causing contraction of <strong>the</strong> vein wall and, ultimately, destruction of<br />
<strong>the</strong> vessel 29, 34 .<br />
1.5.4 Sclero<strong>the</strong>rapy<br />
Sclero<strong>the</strong>rapy involves injecting a sclerosing agent (polidocanol) into <strong>the</strong> varicose vein,<br />
which triggers an inflammatory reaction in <strong>the</strong> endo<strong>the</strong>lium, causing phlebitis and vein<br />
occlusion 35 .<br />
Foam sclero<strong>the</strong>rapy mixes <strong>the</strong> liquid sclerosant with gas to create a larger surface area<br />
by displacing blood within <strong>the</strong> vein 36 . Foam sclero<strong>the</strong>rapy can be used for treating <strong>the</strong><br />
GSV or <strong>the</strong> SSV or to treat <strong>the</strong> tributaries. The dose is adapted to <strong>the</strong> diameter of <strong>the</strong><br />
treated vein.<br />
1.5.5 Mixed treatments<br />
In practice, many surgeons perform a mix of treatments such as surgical ligation and<br />
stripping combined with sclero<strong>the</strong>rapy or EVLT combined with sclero<strong>the</strong>rapy.