Injection Sclerotherapy and Ablation

Abstract

Closure of incompetent superficial veins via endovenous techniques has become the standard of care for treatment of patients with chronic venous insufficiency and symptomatic varicose veins. The safety and efficacy of these procedures have been supported by the peer-reviewed literature, and these procedures have largely replaced the surgical treatments of high ligation and stripping. Three major developments have led to the current endovenous techniques: laser and radiofrequency catheters that deliver thermal energy, tumescent anesthesia, and duplex ultrasonography. This review covers relevant anatomy, pathophysiology, clinical signs and symptoms, diagnostics, treatment, tumescentless therapy, ClariVein (mechanochemical ablation), and the VenaSeal Closure System. Figures show telangiectasias, reticular veins, varicose veins, edema/swelling, hyperpigmentation, venous stasis ulcers, the ClosureFast Catheter, access using the great saphenous vein proximal to the popliteal region, application of tumescent anesthesia, segmental ablation using the ClosureFAST system, the NeverTouch Direct Procedure Kit by AngioDynamics, Varithena foam sclerosant, the ClariVein Occlusion Catheter, and the VenaSeal Sapheon Closure System. Tables list perforating veins of the lower extremity, Clinical, Anatomic, Etiologic, Pathophysiologic classification, and the Venous Clinical Severity Score. This review contains 12 figures, 3 tables, and 103 references