Endothermal Ablation (ETA)
Truncal Vein Treatment
Endothermal Ablation (ETA): The truncal vein (GSV, SSV, AASV or Perforator) causing the varicosities needs to be dealt with. NICE recommends endothermal ablation (either Endovenous Laser Ablation, EVLA or Radiofrequency Ablation, RFA).
At TVC we have been performing endothermal ablation since 2004 and have considerable experience in both EVLA and RFA. Almost all people presenting to us with varicose veins can have their truncal veins reliably treated by endothermal ablation under local anaesthetic as an ambulatory patient. A fine catheter is inserted into the vein under ultrasound guidance. Local anaesthetic is infiltrated around the vein. The catheter is then slowly pulled back along the length of the vein, heating the inside of the vein and killing it from within.
Endothermal ablation has proved to be the most reliable method of eradicating incompetent truncal veins and is also associated with the quickest recovery and lowest risk of complications.
Ultrasound Guided Foam Sclerotherapy (UGFS): We have not found UGFS to be as effective as Endothermal Ablation for treating most truncal veins. There is a higher risk of treatment failure. It can be useful, though, if the vein is not too big or if the vein is too tortuous or too superficial to be treated by ETA. A small needle is inserted onto the vein. We then inject a sclerosant foam that causes the vein to clot off. We can see the foam with ultrasound to determine that we have injected the correct amount to treat the vein.
Surgery: ‘Stripping’ of the GSV or SSV was the preferred technique before endovenous treatments were introduced. The procedure had a terrible reputation due to post-operative bruising, pain and wound complications. In fact, performed by experts using modern techniques, it may be associated with a low risk of complications and reasonably rapid recovery. It cannot compete with ETA, however.
At TVC we recommend conventional surgery very rarely.