Varicose veins and their management

Varicose veins are common and affect a significant proportion of the UK population. They negatively impact on patients’ quality of life and are an important cause of morbidity. Treatment has been shown to improve the quality of life in those affected, and is endorsed by international clinical practice guidelines. In the UK, traditional techniques of saphenofemoral and saphenopopliteal junctional ligation with or without stripping have been largely superseded by minimally invasive, day surgery techniques under local anaesthesia. The most commonly performed include radiofrequency ablation and endovenous laser ablation, both endothermal techniques which may be associated with procedural discomfort and complications relating to the use of thermal energy. More recently, novel techniques, including mechanochemical ablation and cyanoacrylate glue, have entered the clinical arena with promising results. Saphenous sparing techniques also exist, selectively disconnecting refluxing points between the superficial and deep venous systems (CHIVA) or by removing incompetent tributaries via selective phlebectomy (ASVAL). This article discusses the epidemiology, diagnosis and management of varicose veins, including the latest endovascular and targeted open surgical techniques