What’s New in Varicose Veins? (More About … Vascular Surgery) (Clinical Report)
The fundamentals of varicose vein surgery have not changed for many decades and conventional open surgery remains the gold standard against which other treatment modalities are measured. Conventional open surgery is, however, not without problems. The recurrence rate is 10-15% at 2 years and as high as 60-70% after 20 years. (1) Approximately 25% of patients require further surgery and recurrent disease accounts for 20% of all varicose vein surgery. (1) Despite being a relatively minor procedure for a non-life-threatening condition, varicose vein surgery is a common reason for litigation, accounting for 17% of settled claims in general/vascular surgery. Complications include cutaneous nerve injury (5-7%), haematoma (10%), deep vein thrombosis (DVT) ( 2%), pulmonary embolism (0.2-0.5%), wound infection and pain. Endovascular techniques have revolutionised arterial vascular surgery, and a number of techniques in venous surgery are challenging the role of open surgery. These include radiofrequency ablation (RFA), endovenous laser therapy (EVLT), and foam-injection sclerotherapy (FS). Radiofrequency and laser ablation are alternatives to stripping of the greater saphenous vein (GSV). Peripheral varicosities still need treatment with hook phlebectomy or FS. The latter can be used to treat truncal incompetence and peripheral varicosities. These procedures have the advantages that they are minimally invasive and can be performed under local anaesthesia (as a hospital outpatient) or in the consulting room, with similar overall outcomes compared with surgery. All three techniques rely fairly heavily on duplex ultrasound technology.