Endovenous therapies of varicose veins: indications, procedures, efficacy and safety

Venous insufficiency of the lower-extremity is common and the prevalence increases with age. Chronic venous insufficiency has a high impact on patients' health related quality of life (HRQOL) and is associated with considerable health care costs. In addition to classical symptoms, it may result in skin changes and venous ulcers. Since more than hundred years, surgical ligation of the junction with or without stripping has been the standard of care in the treatment of insufficient great and small saphenous veins. However, the recurrence rates are relatively high and surgery may be associated with serious adverse events, considerable down time and is cosmetically suboptimal. In the last decade several minimally invasive techniques have been introduced, to improve efficacy, patients' HRQOL and treatment satisfaction, and to reduce serious side effects, costs and postoperative pain. Dermatologists have played an important role in the development of minimal invasive therapies Ultrasound guided foam sclerotherapy, endovenous laser therapy and radiofrequency ablation are the most commonly used therapies, and challenge surgery as the gold standard of care in patients with varicose veins. The objective of this review is to inform clinicians about these three therapeutic options for saphenous varicose veins and to describe and compare the indications, procedures, efficacy and safety profile.