At 1-year post-treatment, occlusion rates vary from 72% to 89%, which is lower when 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. Potential complications include phlebitis, new telangiectasias, and residual pigmentations. Exceedingly rare complications include DVT [7]. Other nontumescent techniques that are used are cyanoacrylate glue. Risk factors would be allergies to adhesives. Multiple studies have shown that, compared with conventional open surgery and EVLA, chemical sclerotherapy has worse outcomes at 1-, 5-, and 8-year follow-ups, with higher rates of recurrent GSV reflux and saphenofemoral junction failure [33-36]. There are conflicting data on QoL, however, with equivalent improvement reported per the Aberdeen Varicose Vein Severity Score [36] and inferior improvement reported per the Chronic Venous Insufficiency Quality of Life Questionnaire [35]. Iliac Vein Stenting If venography has characterized a central occlusive vascular insult as a culprit for disease that involves the iliocaval segments, angioplasty with possible stenting should be performed. Cases with large ulcers that have decreased in size from prior superficial vein ablation usually require iliac vein stenting to complete ulcer healing [8]. Post-thrombotic iliac vein obstruction can lead to many QoL affecting symptoms including pain, swelling, and VLU. Multiple studies have shown iliac vein stenting to be advantageous with iliac vein stenosis >50%.
Lower Extremity Chronic Venous Disease. At 1-year post-treatment, occlusion rates vary from 72% to 89%, which is lower when 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. Potential complications include phlebitis, new telangiectasias, and residual pigmentations. Exceedingly rare complications include DVT [7]. Other nontumescent techniques that are used are cyanoacrylate glue. Risk factors would be allergies to adhesives. Multiple studies have shown that, compared with conventional open surgery and EVLA, chemical sclerotherapy has worse outcomes at 1-, 5-, and 8-year follow-ups, with higher rates of recurrent GSV reflux and saphenofemoral junction failure [33-36]. There are conflicting data on QoL, however, with equivalent improvement reported per the Aberdeen Varicose Vein Severity Score [36] and inferior improvement reported per the Chronic Venous Insufficiency Quality of Life Questionnaire [35]. Iliac Vein Stenting If venography has characterized a central occlusive vascular insult as a culprit for disease that involves the iliocaval segments, angioplasty with possible stenting should be performed. Cases with large ulcers that have decreased in size from prior superficial vein ablation usually require iliac vein stenting to complete ulcer healing [8]. Post-thrombotic iliac vein obstruction can lead to many QoL affecting symptoms including pain, swelling, and VLU. Multiple studies have shown iliac vein stenting to be advantageous with iliac vein stenosis >50%.