Endovenous Therapy - Find a Specialist and Get Information

The principle behind varicose vein treatment is to remove the dilated section of the vein (the varicose vein). This prevents increased blood reflux into the varicose vein and blood pooling in the leg.

In stripping surgery, doctors remove the diseased vein. In minimally invasive (endovenous) procedures, they seal off the varicose vein from the inside using heat.

This can be done as follows:

• Radiofrequency
• Laser
• Sclerosing agents (liquids or foam)

The most important endovenous procedures include:

• Sclerotherapy (liquid and foam sclerotherapy)
• Radiofrequency therapy (RFA = radiofrequency ablation)
• Laser therapy (EVLT = endovenous laser therapy)
• Mechano-chemical ablation (MOCA)

• Sclerotherapy for Varicose Veins

In sclerotherapy, doctors inject an alcohol-based sclerosing agent (polidocanol; Sclerovein®, Aethoxysklerol®) into the vein in either liquid or foamed form.

This procedure is used primarily for spider veins. For larger veins, it is indicated only in exceptional cases.

The sclerosing agent scleroses the vein from the inside, causing it to collapse, and eventually forms a scar tissue strand after a few days to weeks.

Sclerotherapy can be performed without anesthesia. It takes anywhere from a few minutes to half an hour. Afterward, the patient can go home.

After sclerotherapy of larger veins, the patient should wear medical compression stockings for 2–4 weeks.

Compression therapy is not indicated for spider veins, unless the patient has worn them regularly and tolerated them well in the past.

Small spider veins, in particular, are ideal candidates for sclerotherapy @ Dimid /AdobeStock

• Radiofrequency Therapy

Radiofrequency therapy uses radio waves that damage the diseased vein through the heat generated. To do this, doctors puncture the vein below the knee. They then insert a probe into the affected vein.

This probe delivers the radiofrequency energy to the vein wall. The radio waves heat the vein wall to up to 120° Celsius, thereby destroying proteins in the inner wall of the vein. This causes the cell wall to swell, and the walls subsequently fuse together. The vein closes. 

Radiofrequency therapy can also be performed on an outpatient basis without general anesthesia. However, doctors must inject a solution containing local anesthetics (tumescent solution) along the entire length of the vein.

The goal is to minimize pain during and after the treatment as much as possible. The solution also increases the distance between the vein and the skin. This allows doctors to minimize the risk of burns to the skin’s surface.

Compression therapy is recommended for 2–4 weeks, depending on the severity and size of the varicose veins. In many cases, however, it is not absolutely necessary. A follow-up examination is scheduled according to the treating physician’s recommendation.

Radiofrequency therapy is a gentle catheter-based procedure for treating varicose veins @ rh2010 /AdobeStock

• Laser therapy

Endovenous laser therapy (EVLT) also involves making a small puncture in the vein on the inner side of the lower leg, just below the knee joint.

In addition, doctors insert a vein laser into the varicose vein up to just below the groin. They then heat the laser probe and slowly and gradually withdraw it.

This causes the vein to heat up and seal itself along its entire length from the thigh to just below the knee joint.

The resulting scarring closes off the vein. The backward flow of blood stops after a few days. A few months after treatment, the body breaks down the closed vein or converts it into connective tissue.

Laser therapy can also be performed without general anesthesia. However, the injection of fluid around the vein (tumescent solution = saline solution with a local anesthetic) is still necessary in this case as well.

Laser therapy is performed on an outpatient basis. After the treatment, the patient can go home. To minimize pain and accelerate the closure of the vein, compression stockings are recommended for approximately 2–4 weeks. The treating physician can provide further details and recommendations.

Laser technology makes it possible to treat large varicose veins on the leg using a minimally invasive, outpatient procedure under local anesthesia without general anesthesia @ Rabizo Anatolii /AdobeStock

• Mechanochemical Ablation (MOCA)

In mechano-chemical ablation, doctors also make an incision in the vein, insert a probe, and advance it upward.

What makes this procedure unique is that the probe has a curved tip that rotates at up to 3,500 revolutions per minute.

This causes damage to the vein wall from the inside. Doctors then inject sclerosing foam or adhesive and withdraw the probe.

The vein, which has been damaged from the inside, then closes off due to the injected foam. However, the vein is not closed off by heat, but rather mechanically and chemically.

The advantage of this procedure is that, apart from local anesthesia at the puncture site, no further anesthesia is necessary. The tumescent solution, which is required for thermal treatments, does not need to be infiltrated.

Endovenous procedures offer several advantages over traditional vein stripping:

• First, the treatment can be performed on an outpatient basis at the treating physician’s office.
• No hospital stay is necessary. Patients are only briefly unable to work—or not at all—after the procedure. However, surgical stripping is predominantly performed on an outpatient basis. Therefore, this advantage is increasingly relative.
• Second, local anesthesia is sufficient for pain relief. In contrast, traditional stripping surgery usually requires regional anesthesia and, in some cases, general anesthesia.
• Compared to stripping surgery, the treatment time is shorter. Furthermore, patients report pain less frequently after an endovenous procedure than those who have undergone vein surgery.

Wearing compression stockings is recommended for both procedures in order to:

• reduce pain
• improve results, and
• Accelerate vein closure 

However, you should be aware that endovenous procedures can cause skin burns, which are very painful.

In addition, permanent skin discoloration along the course of the treated vein has been reported, which is often considered cosmetically bothersome.

Studies indicate that the recurrence rate in the groin area is higher with endovenous procedures than with surgical methods.

This is particularly important to consider in cases of multiple procedures and should be taken into account when selecting a treatment method.