Treatment of varicose veins and superficial venous reflux has evolved dramatically over the last 10 years. New, less
invasive treatments have (in most areas) replaced Surgical Vein Ligation and Stripping as the treatment of choice.
Widespread use of ultrasound imaging in experienced hands has allowed physicians to directly target venous
abnormalities and to avoid damaging normal veins.  A brief discussion of some of the treatments available follows.

Laser Ablation

This technique can be used in a wide variety of venous abnormalities to target and close abnormal veins and restore
normal venous function.  It is minimally invasive, can be performed as an outpatient procedure under local anesthesia
and has an outstanding long-term success rate.  Down time is minimal and post procedure discomfort is mild.
Laser treatment is less expensive than Radiofrequency treatment while offering the same or higher success rate.
Both laser and radiofrequency treatments are less expensive in most centers than surgical vein stripping and ligation
which may require anesthesia services and the use of a hospital operating room.  More information can be obtained
at the following site:

Radiofrequency Ablation

Radiofrequency ablation (also sometimes referred to as Closure, copyright VNUS) is also an effective, minimally invasive treatment option although some studies have shown a slightly lower rate of successful treatment.  Radiofrequency ablation has shown good long term results, also with low post-procedure discomfort.  Both Laser ablation and Radiofrequency ablation require the use of ultrasound guidance during the procedure and require less down time than surgical treatment. More information can be obtained at the following site.

Surgical Ligation and Vein Stripping

For many years, surgical ligation and vein stripping was the only available option for treating superficial venous reflux.
In general, Surgical ligation of refluxing vessels results in longer recovery times, often poorer cosmesis and more post-procedural pain than minimally invasive ablation techniques.  Although patients often have long-term relief, venous reflux can recur.  Many people have had (and been helped by) vein stripping in the past, likely someone you know.  It is generally a good idea to discuss vein stripping with someone that has had it before proceeding with this option as other options are now available for treatment that may result in less discomfort and superior results.

Sclerotherapy

Sclerotherapy involves the injection of medication into abnormal veins in order to close them.  Many medications
have been used for Sclerotherapy in the past; currently Sotradecol is the only FDA approved agent available in the
United States. Injections can be performed for larger, varicose veins or can be used for treatment of cosmetic spider
veins. Sclerotherapy is often combined with other treatment (laser ablation for instance) to obtained improved results
for patients suffering with superficial venous reflux. Other medications currently in use include Chromated Glycerin
(for spider veins) and polidocanol.

Ambulatory Phlebectomy

Ambulatory Phlebectomy is a minor surgical procedure which can be performed at same time as laser ablation or
radiofrequency ablation. Local anesthesia (Lidocaine) is used to numb the skin and small (2-3 mm) incisions are
made over varicosities and the varicose veins are removed through the small incisions. Ambulatory phlebectomy
is usually very well tolerated with mild to moderate bruising occurring after the procedure.

Pitfalls of Venous Treatment

Experience is critical; experience in using the ultrasound equipment, experience in performing vein mapping and experience in performing vein treatment procedures. Make sure your physician has a wide range of experience in all facets of evaluation and treatment and that he or she treats a wide range of venous problems. Vein centers should offer adjunctive treatments such as sclerotherapy and ambulatory phlebectomy as these additional skills are often necessary to acheive optimal results.