Venous Ablation Therapy: Indications and Outcomes

Abstract

Venous disease has long been recognized as a progressive, debilitating, and recurrent problem. Until recently, venous insufficiency was often undertreated due to a lack of therapeutic modalities. During the past decade, an explosion in the treatment options has occurred. Endovenous ablation therapy has nearly replaced the conventional surgical treatments for patients with superficial venous insufficiency. Dramatic changes in therapy are also available for deep venous thrombosis but are not the subject of this review. These newer techniques are much less invasive and consequently have reduced risks of wound complications or bleeding. In addition, they can be performed easily in the office setting with local anesthesia. Higher-risk patients can now be considered for these less invasive treatments to reduce their ambulatory venous hypertension. With the lower procedural risks and the dramatically shortened recovery times, earlier intervention can be entertained. This helps prevent the development of venous stasis ulceration and other sequelae of progressive venous insufficiency.

Introduction

Although most concentration has been on the initial management of acute venous thromboembolism, many patients suffer from the long-term ravages of chronic venous disease. This spectrum of chronic venous insufficiency includes limb swelling, skin discoloration, skin ulcerations, and venous varicosities. Venous varicosities often cause cosmetically unappealing findings; however, venous valvular incompetence may result in venous stasis ulcerations that are refractory to therapy without management of the venous varicosities. Endovenous ablation of venous varicosities has largely replaced primary surgical venous ligation and stripping as the primary therapeutic modality. This article will highlight the advances in endovenous management of venous varicosities.