Endovenous therapy of varicose veins: a better outcome than standard surgery?

In the UK approximately one million people are affected with varicose veins. Nearly half a million patients seek advice from their GPs about lower limb varicose veins related symptoms every year. Therefore, they constitute an important part of the elective operations and waiting lists in NHS hospitals. About 40,000 operations for varicose veins were performed in the NHS in 2001. The majority (60-70%) of those patients had an incompetent saphenofemoral junction (SFJ) and great saphenous vein (GSV) reflux. The traditional and most common approach for treating SFJ incompetence and GSV reflux is saphenofemoral disconnection and GSV stripping to the knee. Despite being considered a minor surgical procedure, complications are not uncommon. The minimally invasive endovenous treatment of lower limb's varicose veins has been used over the last few years in many centres across the world. It would appear to be equal to, if not superior to, traditional surgery. It has also been proven to be safe with few serious complications. The most common treatments are endovenous laser ablation and endovenous radiofrequency ablation and chemical sclerotherapy. The case for minimally invasive strategies appears to have been accepted by many patients already and it would appear in trials that they are 'voting with their feet'. Rigorous scientific evidence remains elusive and not yet conclusive. As in all other branches of surgery new technology should be embraced but cautiously, with all results collected and disseminated to finally prove the utility or otherwise of this technique.