Varicose veins. Issue 7 (July 2022) - Bootun, Roshan
Abstract: Varicose veins are common and have a negative impact on people's quality of life. Treatment has been shown to improve the quality of life in those affected and is endorsed by international clinical practice guidelines. In the UK, traditional techniques of saphenofemoral and saphenopopliteal junctional ligation with or without stripping have been largely superseded by minimally invasive day surgery techniques under local anaesthesia. The most performed procedures include radiofrequency ablation and endovenous laser ablation, both of which may be associated with procedural discomfort and complications relating to the use of thermal energy. More recently, novel techniques, including mechanochemical ablation and cyanoacrylate glue, have entered the clinical arena with promising results. However, newer complications are also emerging (especially for cyanoacrylate). Saphenous sparing techniques also exist, selectively disconnecting refluxing points between the superficial and deep venous systems (CHIVA) or by removing incompetent tributaries via selective phlebectomy (ASVAL). This article discusses the epidemiology, diagnosis, and management of varicose veins, including the latest endovascular and targeted open surgical techniques.