A meta-analysis showed not only no statistically significant difference in long-term outcomes between conventional surgery and endovenous therapy but also no statistically significant difference in long-term outcomes between RFA and EVLA or conventional surgery [30]. An additional meta-analysis including 792 EVLA-treated and 785 RFA-treated patients demonstrated the same safety and efficacy between the 2 treatment cohorts. Outcomes included 3-day and 10-day pain scores, 1 month and 1 year QoL, occlusion, thrombophlebitis, hematoma, and recanalization. Though limited, data from this meta-analysis suggest RFA seems to have a lower overall risk of complication when compared to EVLA [31]. We can conclude that the aggregate of evidence supports that ablation of saphenous veins provides significant benefits compared with compression [15]. Compression Sclerotherapy Compression sclerotherapy has been used effectively in the treatment of varicose veins, reticular veins, and telangiectasias [7,14]. In sclerotherapy, a liquid or foamed sclerosing drug is injected into the lumen of the varicose vein. This sclerosant is a chemical that damages the vein wall and ultimately occludes it secondary to fibrotic transformation of the vessel. Foamed sclerosant is used to increase the surface area by which the luminal wall can be treated. Doppler US of the GSV ablated with foam at 1-year post-treatment demonstrated occlusion rates vary from 72% to 89%, which is lower compared to EVLA at 1 year [7,32]. Sclerosant can also be administered over a rotating wire, which causes local trauma to the vessel. This form of mechanochemical ablation has closure rates that vary from 88% to 94% in the literature [7]. Advantages of these chemical ablative techniques include a lack of potential thermal injury that could injure the skin, nerves, muscles, and nontarget blood vessels, which is rarely seen with endovenous ablation. Additionally, because of a lack of thermal energy, tumescent anesthesia is not needed.
Lower Extremity Chronic Venous Disease. A meta-analysis showed not only no statistically significant difference in long-term outcomes between conventional surgery and endovenous therapy but also no statistically significant difference in long-term outcomes between RFA and EVLA or conventional surgery [30]. An additional meta-analysis including 792 EVLA-treated and 785 RFA-treated patients demonstrated the same safety and efficacy between the 2 treatment cohorts. Outcomes included 3-day and 10-day pain scores, 1 month and 1 year QoL, occlusion, thrombophlebitis, hematoma, and recanalization. Though limited, data from this meta-analysis suggest RFA seems to have a lower overall risk of complication when compared to EVLA [31]. We can conclude that the aggregate of evidence supports that ablation of saphenous veins provides significant benefits compared with compression [15]. Compression Sclerotherapy Compression sclerotherapy has been used effectively in the treatment of varicose veins, reticular veins, and telangiectasias [7,14]. In sclerotherapy, a liquid or foamed sclerosing drug is injected into the lumen of the varicose vein. This sclerosant is a chemical that damages the vein wall and ultimately occludes it secondary to fibrotic transformation of the vessel. Foamed sclerosant is used to increase the surface area by which the luminal wall can be treated. Doppler US of the GSV ablated with foam at 1-year post-treatment demonstrated occlusion rates vary from 72% to 89%, which is lower compared to EVLA at 1 year [7,32]. Sclerosant can also be administered over a rotating wire, which causes local trauma to the vessel. This form of mechanochemical ablation has closure rates that vary from 88% to 94% in the literature [7]. Advantages of these chemical ablative techniques include a lack of potential thermal injury that could injure the skin, nerves, muscles, and nontarget blood vessels, which is rarely seen with endovenous ablation. Additionally, because of a lack of thermal energy, tumescent anesthesia is not needed.