Endovenous (minimally invasive) procedures for treatment of varicose veins: The gentle and effective alternative to high ligation and stripping operations

Thermal ablation of saphenous vein varicosis has developed into a standard procedure for treatment of varicose veins. The clinical success of the endovenous thermal procedure is comparable to high ligation and stripping operations and a significant difference between these groups could not be detected in long-term analyses. The only difference is in the genesis of saphenofemoral recurrence detected by duplex ultrasound: neoangiogenesis occurs after high ligation and stripping operation and after endovenous ablation of the great saphenous vein a recurrence occurs predominantly via a residual anterior accessory saphenous vein (AASV). Reduction of costs by an increase in endovenous procedures carried out in an outpatient setting in comparison to stripping operations, which are still frequently carried out in Germany (in comparison to other countries) as an inpatient procedure, have meanwhile been confirmed. An endovenous crossectomy (i.e., high ligation) should be strived for. Nonthermal endoluminal catheter procedures are predominantly reserved for treatment of the short saphenous vein.