Endovenous thermal treatment of trunk vein insufficiency

Endovenous thermal procedures for ablation and hemodynamic elimination of insufficient saphenous veins are well established and scientifically confirmed treatment options for varicose veins. Numerous randomized controlled trials and meta-analyses document a lower pain burden and faster postoperative convalescence compared to open operations with crossectomy and stripping. In addition, the endothermal procedures are associated with a low risk profile and high long-term effectiveness. International guidelines recommend these procedures as the first-line treatment option for symptomatic saphenous vein insufficiency. Sonography is an integral part of the endovenous procedures in order to ensure the exact placement of the treatment probes and the safe elimination of the trunk vein. The thermal energy is intended to cause irreversible denaturation, complete ablation and permanent hemodynamic elimination of the treated venous segments without altering the deep venous system or perivenous tissue. While the systems for radiofrequency ablation (RFA) have feedback mechanisms with automatic regulation of the thermal energy, with endovenous laser ablation (EVLA) the thermal tissue effects must be estimated through the choice of laser power and retraction speed. As with all invasive procedures, the endovenous thermal procedures also require adequate theoretical and practical training and instruction in order to minimize risks and to exploit the potential of these treatment options. The importance of positioning the treatment probes to achieve the shortest possible saphenous stump and the simultaneous treatment of non-refluxing accessory veins are the subject of current scientific discussion.