Varicose Veins by Felipe Collares Salomao Faintuch

Author:Felipe Collares,Salomao Faintuch
Language: eng
Format: epub
Publisher: Thieme Medical Publishing Inc.
Published: 2017-05-22T16:00:00+00:00

6 Endovenous Thermal Ablation

Amy R. Deipolyi, Gloria M. Martinez Salazar, and Felipe B. Collares

6.1 Introduction

Percutaneous endovascular thermal ablation (EVTA) for varicose veins has been proven to achieve results comparable to surgical venous stripping with less associated periprocedural morbidity and faster recovery, attractive features that allow patients to be treated in the outpatient setting. Its main advantages are that it allows for the exclusive use of local anesthetic, is minimally invasive, and is performed in the outpatient procedure setting with immediate patient discharge and ambulation. Choice of treatment for varicose veins depends on the presence or absence of venous reflux. There are several therapies available when reflux is not detected: sclerotherapy, transdermal laser treatment, ablation with echosclerotherapy, and ambulatory phlebectomy. 1,​ 2,​ 3

When reflux is diagnosed, the classically performed intervention is saphenofemoral junction (SFJ) ligation with saphenous venous stripping. However, with the advent of ultrasound (US) and minimally invasive techniques resulting in a better understanding of anatomy and physiopathology of the venous disease, this approach has been increasingly replaced by EVTA under US guidance. 4,​ 5

Endovascular techniques for the treatment of varicose veins have emerged as a safe and effective alternative to traditional surgical therapy. 5 Recent clinical trials have shown equivalent long-term results compared to surgical vein stripping. 4,​ 5 Practitioners involved in the care of these patients should have a thorough understanding of imaging aspects of venous insufficiency, as it relates to pre- and postprocedure patient evaluation, as well as to the performance of image-guided intervention.

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