Techniques For Saphenous Ablation, How To Choose Your Strategy

With the enormous amount of treatment techniques available for saphenous ablation, it can be difficult to choose the best strategy. Not only are there different techniques like surgical and endovenous, thermal and non-thermal, and tumescent and non-tumescent, there is also the option to stage treatment, or to perform them in a single combined session. Fortunately, the recent European Society for Vascular Surgery (ESVS) practical guidelines on the treatment of chronic venous disease, provides flowcharts to guide physicians. For the great and small saphenous vein, as well as the anterior accessory saphenous vein, endovenous thermal ablation is the first-choice treatment. However, in some cases, a non-thermal non-tumescent technique may be preferred, or even high ligation and stripping if endovenous options are not available. This review gives an overview of the different techniques, compares them and discusses considerations when deciding on treatment strategies.