J Korean Med Assoc.
2022 Apr;65(4):209-216. 10.5124/jkma.2022.65.4.209.
Second-generation treatment of varicose veins: endovenous thermal ablation by laser or radiofrequency ablation
- Affiliations
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- 1Division of Vascular and Transplant Surgery, Department of Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 2Division of Transplantation and Vascular Surgery, Department of Surgery, Chungnam National University College of Medicine, Daejeon, Korea
- KMID: 2529240
- DOI: http://doi.org/10.5124/jkma.2022.65.4.209
Abstract
- Background
Endovenous thermal ablation (EVTA) is the second-generation treatment of varicose veins in the lower extremities. It has overcome the shortcomings of the first-generation treatment of high ligation and stripping. Further, it is the basis for the development of the third-generation treatment with endovenous glue ablation. It is currently recommended as the first-line treatment for varicose veins accompanied by great saphenous vein incompetence.
Current Concepts
EVTA involves obliterating the varicosed veins by applying thermal energy to blood or vein wall. It can be performed by laser or radiofrequency ablation methods, under local anesthesia. The treatment results are excellent and show lesser pain and faster recovery compared to the first-generation treatment. However, complications include endovenous heat-induced thrombosis, deep vein thrombosis, ecchymosis, and phlebitis.
Discussion and Conclusion
To enhance the therapeutic effect and reduce the complications of EVTA, sufficient tumescent anesthesia, a controlled number of firing in radiofrequency ablation, and use of the novel highwavelength laser and a radial catheter tip in endovenous laser ablation are recommended. In addition, proficiency in other generations of varicose vein treatments could help in various situations.
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