الفهرس 
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Abstract
SUMMARY
V
aricose veins, a common problem with effects on quality of life, account for a significant cost burden on the health care system. They are enlarged, tortuous, subcutaneous veins that commonly occur in the legs.
Varicose veins are caused by faulty valves and decreased elasticity in the vein walls, which allow blood to backflow and pool. This is known as venous reflux. The affected veins enlarge and appear as green, dark blue or purple protrusions just below the skin’s surface.
The severity of symptoms associated with varicose veins varies and may include pain, heaviness, pruritis, ulceration, skin discoloration and edema. Severe symptoms include thrombophlebitis, bleeding and venous dermatitis, which often require intervention.
A variety of therapies are available for treating varicose veins, including conservative therapies, surgical interventions and nonsurgical intervention. Conservative therapies are commonly recommended in asymptomatic patients or those with mild to moderate symptoms. Surgical interventions generally become necessary when symptoms of varicose veins significantly impinge on the patient’s quality of life.
Junction ligation with or without vein stripping is generally appropriate when the GSV and SSV have reflux or incompetence is demonstrated on duplex scanning. This intervention is generally performed as an inpatient procedure under general anesthetic. Junction ligation involves tying off the vessel at the SFJ or SPJ. Ligation alone usually leads to high rates of varicose vein recurrence; therefore, patients often require after-care treatment, such as sclerotherapy. In most cases, ligation is accompanied by GSV stripping and is generally regarded as the treatment of choice for varicose veins.
Two endovenous modalities include radiofrequency ablation (RFA) and endovenous laser therapy (ELT). Both treatments involve inserting a heat-generating laser fiber or catheter into the incompetent saphenous vein, positioned just below the SFJ or SPJ. Heat is generated through laser (ELT) or radiofrequency (RFA) energy, and as the fiber or catheter is slowly removed down the length of the vein, endothelial and venous wall damage occurs, causing contraction of the vein wall and ultimately destruction of the vessel.
New techniques are less invasive than the conventional surgery, and are associated with shorter postoperative recovery, owing to less pain, as well as fewer complications such as haematoma, groin infection and nerve damage.
Minimally invasive endothermal treatments have replaced surgical ligation and stripping in the management of chronic venous insufficiency (CVI) and are now considered the standard of care.
Newer techniques have emerged in the last few years in an attempt to further minimize the procedural discomfort associated with endothermal procedures. These new techniques are designed to avoid tumescent anesthesia (TA).
The two currently available methods used to achieve ablation of the great saphenous vein are the Closure procedure using a radiofrequency (RF) catheter and generator, and the endovenous laser ablation (EVLT) procedure using a laser fiber and generator. Both systems use electromagnetic energy to destroy the great saphenous vein in situ.
The ideal treatment for lower extremities primary varicose veins should be relatively noninvasive, repeatable if necessary, relatively safe and free from significant complications, effective in eliminating points of leakage, cost effective, cosmetically acceptable and obviate the necessity for extended periods of unemployment or absence from usual daily activities.
Surgical treatment in the form of disconnection of the sapheno-femoral junction (SFJ) along with stripping of the great saphenous vein (GSV) and multiple phlebotomies is considered the standard treatment of varicose veins. Excellent results are achieved as long as every source of reflux is eliminated.
There are newer techniques available to destroy the GSV in the thigh, without physically removing the vein by stripping. The alternative techniques in common use are radiofrequency ablation (RFA) and endovenous laser ablation (EVLA). There is now reasonable evidence that radiofrequency ablation is a slightly superior procedure especially for perioperative bruising and pain when compared with endovenous ablation.
Endovenous GSV ablation with ClosureFast or 1470-nm EVLA with RTF had similarly short term outcomes And were equally effective clinically with durable gains in disease-specific QOL. The treatments were equally associated with minimal postprocedural pain scores and short recovery times