Algorithm to Select the Treatment Modality for the Incompetent Saphenous Vein

Varicose vein procedures are common vascular surgeries. Over the last two decades, the management of saphenous vein reflux has evolved from traditional surgical stripping (SS) to less invasive endovenous therapies (EVTs), including thermal and non-thermal ablation. As a result, EVT is now the preferred approach for treating incompetent saphenous veins. Although all methods demonstrate comparable effectiveness and high closure rates, both SS and EVT have unique advantages and disadvantages. SS ensures the complete removal of refluxing truncal veins but carries the risk of complications related to invasiveness, such as groin infection, lymphatic issues, and nerve damage. EVT is minimally invasive and promotes a quicker recovery and return to work. However, thermal techniques can cause heat-related nerve or skin damage and necessitate tumescent injections, whereas non-thermal approaches may lead to thrombophlebitis or allergic reactions. Thus, the selection of optimal treatment should consider both the anatomical features of the refluxing vein and the specific characteristics of each procedure. This review aims to compare the clinical outcomes of these procedures and propose a suitable decision-making process for selecting the appropriate treatment for incompetent saphenous veins.