Current International Guidelines for the Treatment of Varicose Veins.
NICE: The National Institute for Health and Care Excellence (UK) have released guidelines for the diagnosis and management of varicose veins. (1)
These guidelines provide further support that firstly Endothermal Ablation and secondly Ultrasound Guided Foam Sclerotherapy are the recommended techniques for the removal of varicose veins. Surgical stripping of varicose veins should only be considered if these techniques are NOT suitable.
These guidelines are published on page 10.
1.3.2 For people with confirmed varicose veins and truncal reflux:
- Offer endothermal ablation (see Radiofrequency ablation of varicose veins [NICE interventional procedure guidance 8] and Endovenous laser treatment of the long saphenous vein [NICE interventional procedure guidance 52]).
- If endothermal ablation is unsuitable, offer ultrasound-guided foam sclerotherapy (see Ultrasound-guided foam sclerotherapy for varicose veins [NICE interventional procedure guidance 440]).
- If ultrasound-guided foam sclerotherapy is unsuitable, offer surgery.
In 2012 the Society for Vascular Surgery and the American Venous Forum published evidence based clinical practice guidelines on recommendations for evaluation, classification, outcome assessment and therapy of patients with varicose veins and more advanced chronic venous insufficiency. Advancements in technology and surgical techniques have resulted in vast improvements in the prevention and management of varicose veins. “It is critical that surgeons are aware of the latest diagnostic strategies and the less invasive and more effective treatment techniques for treating the disease,” says Peter Gloviczki, MD, who chaired the SVS/AVF Venous Guideline Committee. (2) (3)
For treatment of the incompetent GSV, EndoVenous Thermal Ablation (radiofrequency, RF, or EndoVenous laser therapy, EVLT) is recommended over high ligation and stripping of the saphenous vein. It is recommended phlebectomy or sclerotherapy to treat varicose tributaries and suggest foam sclerotherapy as an option for the treatment of the incompetent saphenous vein
Guideline 11, EndoVenous Thermal Ablation
11.1 EndoVenous Thermal Ablations (laser and radiofrequency ablations) are safe and effective, and we recommend them for treatment of saphenous incompetence.
11.2 Because of reduced convalescence and less pain and morbidity, we recommend EndoVenous Thermal Ablation of the incompetent saphenous vein over open surgery.
Guideline 12. Sclerotherapy of varicose veins
12.1 We recommend liquid or foam sclerotherapy for telangiectasia, reticular veins and varicose veins.
12.2 For treatment of the incompetent saphenous vein, we recommend EndoVenous Thermal Ablation over chemical ablation with foam.
The minimally invasive treatment options are offered as outpatient procedures; they are performed in an office setting under local anaesthesia, with significantly less complications than classical surgical stripping procedures and permit early return to work.
Clinical practice guidelines of the European Society for Vascular Surgery (4)
For the treatment of great saphenous vein reflux in patients with symptoms and signs of chronic venous disease, endovenous thermal ablation techniques are recommended in preference to surgery
Class 1, Level A3
1. (UK) NCGC. Varicose Veins in the Legs: The Diagnosis and Management of Varicose Veins. National Institute for Health and Clinical Excellence: Guidance. 2013.
2. Gloviczki P, Gloviczki ML. Guidelines for the management of varicose veins. 2012..
3. Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, et al. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. Journal of Vascular Surgery. 2011.
4. De Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, et al. Editor's Choice e Management of Chronic Venous Disease. .