The treatment of venous disease has been transformed over the past two decades by the development of minimally invasive interventional techniques that offer substantially better outcomes, shorter recovery times, and greater patient comfort than the open surgical approaches that preceded them. Vascular specialists can now offer treatments for most forms of venous insufficiency that are performed as outpatient procedures under local anesthesia, with patients typically returning to normal activities within days.
Endovenous thermal ablation — the flagship procedure of modern vascular interventional practice — uses heat energy to seal off incompetent superficial veins from the inside. A thin catheter is introduced into the affected vein through a needle puncture under ultrasound guidance and positioned along the length of the vessel. Laser or radiofrequency energy delivered through the catheter tip heats the vein wall to a temperature that causes permanent closure. The sealed vein is subsequently absorbed by the body over the following weeks, with excellent cosmetic results.
Ultrasound-guided foam sclerotherapy offers an alternative approach for smaller and more complex venous networks. A foam preparation of sclerosant chemical is injected under ultrasound guidance into the veins to be treated, where it displaces blood and causes an inflammatory reaction that permanently occludes the treated vessel. This approach is particularly useful for treating varicose branches and recurrent veins where thermal ablation may be technically challenging, and it can be performed in a clinic setting without any anesthesia.
Mechanical occlusion techniques — including mechanochemical ablation, which combines a rotating catheter with simultaneous sclerosant injection — represent another addition to the vascular specialist’s therapeutic armamentarium. These techniques cause vein occlusion through mechanical injury to the vessel wall combined with chemical injury, without the use of heat, making them suitable for patients in whom thermal techniques carry specific risks.
For patients with DVT, the therapeutic landscape has also advanced considerably. Modern oral anticoagulants — the direct oral anticoagulants — have replaced warfarin as the standard of care for DVT treatment in most patient groups, offering predictable anticoagulation without the need for regular blood monitoring. For patients with extensive or limb-threatening DVT, catheter-directed thrombolysis — the delivery of clot-dissolving medication directly into the affected vein via catheter — can achieve rapid clot resolution and preserve vein function that would otherwise be permanently lost.
