Endovenous thermal ablation

Endovenous thermal ablation (ETA) is quickly replacing traditional stripping surgery in many countries. The advantages are quite obvious: Instead of a surgical access to the groin or to the back of the knee, only punctures are needed. Furthermore, local anesthesia rather than spinal or general anesthetic suffices. No operating room and no hospital bed are required.

The Australian Medical Services Advisory Committee has determined as early as in 2008, that endovenous thermal ablation for varicose veins “appears to be more effective in the short term, and at least as effective … as vein stripping for the treatment of varicose veins. It also found that “occurrence rates of more severe complications such as thrombosis, nerve injury and paraesthesia, post-operative infections and haematomas, appears to be greater after … stripping than after ETA”. In 2012, both the American Society for Vascular Surgery and the American Venous Forum stated in their guidelines, that “endovenous thermal ablations shoud be recommended over open surgery as the first line of treatment of varicose veins … because of their minimally invasive nature and similar or better early-term and equivalent midterm results“. In the newly puglishes guidelines of the European Society for Vascular Surgery, „ETA techiques were recommended in preference to surgery fort he treatment of long saphenous vein reflux patients“.

For thermal ablation, a catheter is inserted into and along the refluxing vein. This is, in most instances, the long saphenous vein, the short saphenous vein or both. After injection of local anesthetic, the catheter heats the vein to 110-120 degrees Celsius. This leads to the occlusion of the vein. Over time, the occluded vein is totally absorbed by the organism.

From a technical viewpoint, more than one heating technique is available. The most successful include radiofrequency (ClosureFast® = Venefit®) and radial laser with 1470 nm wavelength (Biolitec ELVeS®)

ETA requires specialized training for doctors and expensive equipment. ETA is performed as an outpatient procedure and does not require the use of an operating theatre, nor does the patient need a general anaesthetic. Doctors must use high frequency ultrasound during the procedure to visualize the anatomical relationships between the saphenous structures. As many other practitioners, we usually perform phlebectomy or ultrasound guided sclerotherapy at the time of endovenous treatment. Follow-up treatment to smaller branch varicose veins is sometimes needed after the initial procedure.