MULTIMODAL TREATMENT OF VARICOSE VEINS. LITERATURE REVIEW

Abstract

Objectives. This study aims to synthesize recent evidence on the multimodal treatment of varicose veins, analyzing the efficacy, safety, and impact on quality of life of the most commonly used techniques: sclerotherapy, CHIVA, ASVAL, endovenous laser ablation (EVLT), radiofrequency ablation (RFA), and n-butil-cyanoacrylate ablation (NBCA).

Methods. A narrative review of the literature was conducted, including randomized controlled trials, meta-analyses, and clinical guidelines published between 2010-2024. The analyzed key outcomes were primary occlusion rate, recurrence rate, complications (DVT, EHIT), postoperative pain, and time to return to normal activities after surgery/procedure.

Results. EVLT and RFA showed occlusion rates of 93-98%, with recurrence rates of 10-15% at 5-year follow-up and a DVT incidence of <2%. Ultrasound-guided foam sclerotherapy achieved an 80-90% occlusion rate and low post-procedural pain. CHIVA and ASVAL preserve the great saphenous vein, reduce venous hypertension, and are associated with a 20-30% reduction in recurrence compared with stripping. NBCA demonstrated 95-98% closure rates, requires no tumescent anesthesia, and allows immediate ambulation. Combined approaches (e.g., EVLT + sclerotherapy) reduced reintervention rates by up to 25% and improved cosmetic outcomes.

Conclusions. Multimodal treatment of chronic venous insufficiency represents the current standard of care, offering superior outcomes compared to conventional surgery. Treatment choice should be individualized according to venous anatomy and patient goals. Integration of combined techniques, ultrasound-guided follow-up, and long-term monitoring are essential for maintaining outcomes and preventing recurrence.