Endovenous

Endovenous refers to treatments delivered inside veins to treat venous insufficiency, most commonly for varicose veins in the legs. The term covers techniques that occlude a malfunctioning superficial venous segment while preserving flow in deeper veins.

The main methods are endovenous thermal ablation and endovenous chemical ablation. Thermal methods include endovenous laser ablation (EVLA) and endovenous radiofrequency ablation (EVRA), which heat the vein. Chemical ablation uses sclerosants, often foamed, delivered endovenously.

Procedure: performed under duplex ultrasound guidance with local anesthesia, often with tumescent anesthesia around the vein. A needle or catheter is inserted and advanced to the incompetent segment. Energy is applied while the catheter is withdrawn, and the vein closes.

Indications include incompetent great saphenous vein, small saphenous vein, and tributaries causing varicose veins or reflux symptoms. It is typically considered after conservative treatments or when surgery is not preferred.

Recovery and outcomes: most patients can resume daily activities within days. Occlusion rates are high in the short term, with favorable symptom relief and cosmetic results. Compared with stripping, endovenous treatments involve less pain and faster recovery.

Risks: potential complications include endothermal heat-induced thrombosis, deep vein thrombosis, nerve injury, skin burns, phlebitis, infection, or recanalization.

History: endovenous techniques emerged in the late 20th century, with EVRA and EVLA becoming common in the 2000s. They are offered in outpatient vascular clinics and hospitals.