Varicose Vein Treatment Comparison of Thermal, Nonthermal, & Surgical Approaches
In This Article:
- Overview of varicose vein treatments with thermal ablation, nonthermal ablation, microphlebectomy, and surgery
- Comparison of treatment types for the removal of varicose veins
- Benefits and drawbacks of:
- Laser ablation
- Foam sclerotherapy
- Mechanochemical ablation (MOCA)
- Cyanoacrylate vein glue
Nonthermal ablation – A wire, chemical foam (sclerotherapy), glue, or a combination of these are injected into the varicose vein. The vein collapses on itself and eventually closes.
Microphlebectomy – A hooked instrument is used to remove the varicose vein through small, millimeter sized incisions on the skin surface.
Surgery – Varicose veins are detached and then removed through small cuts in the skin. The remaining veins are re-routed and tied together.
A device that produces high frequency, alternating electrical current is delivered through a thin needle or catheter into the vein. High heat is generated by the electrical current, and causes damage to the vein wall . Due to the heat generated, a cold anesthetic saline mixture called tumescent anesthesia is injected locally to reduce pain and to prevent nerve injury. The VNUS Closure procedure is a radiofrequency ablation treatment that can be done in the VIP office.
Benefits of Radiofrequency Ablation
● Effective in treating larger varicose veins with diameters of 5 to 8 mm.
Drawbacks of Radiofrequency Ablation
● Nerve injury is very rare, but possible
● It may be difficult to treat tortuous (twisted) veins or partially thrombosed (obstructed) veins.
Benefits of Laser Ablation
● Laser ablation can treat large varicose veins and veins that are recurrent.
Drawbacks of Laser Ablation
● Skin discoloration, nerve injury, and skin burns are possible risks of laser ablation treatment.
Benefits of Foam Sclerotherapy
● Foam sclerotherapy is effective in treating varicose veins that are large, lie deep below the surface of the skin, and are highly branched or twisted [2, 3].
● Because foam produces small bubbles, duplex ultrasound can be used to guide treatment .
● Partially occluded varicose veins can be treated.
Drawbacks of Foam Sclerotherapy
● Multiple treatment sessions may be necessary for complete vein clearance.
● Adverse reactions, such as ulceration, can occur following treatment.
Mechanochemical Ablation (MOCA)
Benefits of MOCA
● Superficial veins and veins below the knees are easily treated with MOCA.
Drawbacks of MOCA
● Tortuous (twisted) and partially thrombosed (obstructed) varicose veins are difficult to treat with MOCA.
● MOCA is not as effective on recurrent veins.
Cyanoacrylate Vein Glue
Benefits of Cyanoacrylate Vein Glue
● Works well for superficial and small veins.
● Can be used to treat recurrent veins.
Drawbacks of Cyanoacrylate Glue
● Patients with adhesive or tape allergies may be sensitive and have cross-reactivity.
● The glue remains in the vein permanently and stays there as a foreign body.
Benefits of Microphlebectomy
● Effective for removing large, bulging varicose veins that are close to the surface of the skin .
● Incisions are 1 to 3mm in length and usually require no sutures.
Drawbacks of Cyanoacrylate Glue
● Blood collected under the skin during the procedure can cause bruising or hematoma.
● Fragments of unremoved varicose vein can cause inflammation and irritation.
● Numbness and tingling may result if a sensory nerve is injured.
Varicose Vein Surgery
Surgical Ligation and Vein Stripping
Large varicose veins, typically >1.5 cm, that are at risk of hemorrhaging or that have a history of recurrent ulceration, can be surgically excised while the patient is under anesthesia.
Benefits of Surgery
● Low vein recurrence and neovascularization (new veins).
● Can remove larger varicose veins that would otherwise be untreatable with other minimally invasive thermal or nonthermal ablation techniques.
Drawbacks of Surgery
● Can be invasive and patients may experience more postoperative pain.
● Recovery time can be longer with a higher rate of complications.
Which Varicose Vein Treatment is Best?
To summarize, there are many viable options when it comes to varicose vein treatment, and the most favorable treatment can depend on physician preference, patient preference, or on the complexity and extent of vein disease. We highlight the strengths, benefits and risks of each treatment in the table below . You can schedule an appointment with one of our vein specialists in Visalia, CA today to discuss further.
|Technique||Types of Veins Treated||Benefits||Risks|
|Foam Sclerotherapy||Tortuous varicose veins, superficial veins, recurrent veins, partially occluded varicose veins||Can treat deeper varicose veins that branch||Skin discoloration possible, brief tenderness|
|Mechanochemical Ablation (MOCA)||Smaller, superficial varicose veins||Combines mechanical and chemical techniques, sclerosant is well distributed||Local adverse reaction possible|
|Glue||Superficial veins, recurrent varicose veins, varicose veins with <1 cm diameter||Glue is well distributed into deeper veins and throughout varicosities||Allergic reaction, immune reaction to foreign body|
|Laser Ablation||Larger varicose veins, recurrent varicose veins||Laser parameters can be altered to tailor treatment||Nerve injury possible, skin burn possible|
|Radiofrequency Ablation||Larger varicose veins, recurrent varicose veins||Large, superficial varicose veins can be targeted||Nerve injury possible|
|Microphlebectomy||Short varicose vein segments near the surface of the skin||Can treat isolated varicose veins, large varicose veins often have quicker and better cosmetic results than with foam sclerotherapy||Nerve injury possible, may require second stage treatment with another technique|
|Surgery||Large varicose veins >1.5 cm in diameter, veins with potential to hemorrhage or that are very occluded||Best treatment for large veins that cannot be removed with minimally invasive techniques||Infection, postoperative pain|
 Patient education: Vein ablation (The Basics). UpToDate. Accessed March 2020.
 Scovell, S. Liquid, foam, and glue sclerotherapy techniques for the treatment of lower extremity veins. UpToDate. Accessed March 2020.
 Morrison, N., Gibson, K., Vasquez, M., Weiss, R., Cher, D., Madsen, M., & Jones, A. (2017). VeClose trial 12-month outcomes of cyanoacrylate closure versus radiofrequency ablation for incompetent great saphenous veins. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 5(3), 321–330.
 Passman, MA. Approach to treating symptomatic superficial venous insufficiency. UpToDate. Accessed March 2020.
 Lupton JR, Alster TS, Romero P. Clinical comparison of sclerotherapy versus long-pulsed Nd:YAG laser treatment for lower extremity telangiectases. Dermatol Surg 2002; 28:694.
 Scovell, S. Radiofrequency ablation for the treatment of lower extremity chronic venous disease. UpToDate. Accessed March 2020.
 Eidt, JF. Open surgical techniques for lower extremity vein ablation. UpToDate. Accessed May 2020.
 Biemans AA, Kockaert M, Akkersdijk GP, van den Bos RR, de Maeseneer MG, Cuypers P, Stijnen T, Neumann MH, Nijsten T. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg. 2013 Sep;58(3):727-734.e1. Epub 2013 Jun 13.
 Dillavou, E., Kiguchi, M. Comparison of methods for endovenous ablation for chronic venous disease. UptoDate. Accessed March 2020.
The Materials available on visaliavips.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.
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