A decade ago a doctor’s advice to a patient with varicose veins was easy: the alternatives are injection sclerotherapy or surgery. Only these techniques have existed long enough to know about both their shortand long-term results. Results have generally been disappointing, with high recurrence rates as time goes by1. The past few years have witnessed an explosion in types of minimally invasive treatment technique and this has made decisions about varicose vein treatment more difficult. These techniques include thermal ablation in the form of endovenous laser ablation or radiofrequency ablation (RFA), and foam sclerotherapy.
The introduction of these new methods has been rapid, before any adequate scientific evaluation. It is based on the enthusiasm of practitioners and some short-term trials that demonstrate equivalence of outcome with conventional surgery, but with less postoperative discomfort and speedier return to normal activity. In addition, the new techniques can be employed under local anaesthetic, often in an outpatient setting, thereby freeing operating theatre time and potentially improving cost efficacy. Increasing access to information has encouraged patients to seek these new treatments, often after visiting commercially sponsored websites. Many feel bewildered by the available choice, while being seduced by the prospect of involvement in decision making.