Superficial varicosity is a common medical condition that is symptomatic in 20-30% of the US population. Classic symptoms of venous insufficiency are ankle edema, leg fatigue, aching, discomfort, and muscle cramps. Some patients develop associated complications, including stasis dermatitis, lipodermatosclerosis, skin atrophy, superficial thrombophlebitis, and venous ulcers. The treatment of varicose veins reduces symptoms and complications of chronic venous insufficiency and improves quality of life. Superficial varicose veins are often due to failure of the valves in the saphenous vein and at the saphenofemoral junction (SFJ), causing venous reflux. Until recently, traditional ligation and stripping has been the standard of care in the treatment of truncal varicosities. But there are some disadvantages, including a 20% recurrence rate in 5 years, requirement of 2-6 weeks of downtime, associated risks of general anesthesia, scars, and possible neurovascular and lymphatic vessel damage. As an alternative, there are currently available endovenous treatment options for superficial varicose veins: ultrasound guided foam sclerotherapy, endovenous radiofrequency, and endovenous laser treatment. These are minimally invasive in-office procedures with less pain, early ambulation, and less recovery time. In this chapter, we review techniques for endovenous laser and endovenous radiofrequency treatments.
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