Complications of Endovenous Treatments, Including: Thermal, Nonthermal, Sclerotherapy, and Foam Ablations

Introduction

Endovenous ablation has become the treatment of choice for chronic venous disease (CVD) and chronic venous insufficiency (CVI). There are many different types of modalities to treat CVI, including thermal energy commonly with endovenous laser ablation (EVLA), radiofrequency ablation (RFA; ClosureFast, Medtronic), and less commonly with steam and cryotherapy. In addition, nonthermal ablations are effective in venous ablation and include ultrasound-guided foam sclerotherapy (USGFS), mechanical occlusive chemical ablation or mechanochemical ablation (MOCA; ClariVein, Vascular Insights, ClariVein South Jordan UT), cyanoacrylate glue (CAG; Sapheon, VenaSeal, Medtronic, VenaSeal Minneapolis MN), and liquid sclerotherapy. Physician compounded foam is also used in the treatment of truncal varicose veins and tributaries, as well as recurrent varicose veins. Recently, proprietary polidocanol endovenous microfoam (PEM; Varithena, BTG International Ltd., Varithena St. Paul MN) ablation has been brought to the market in the United States, following several studies evaluating safety and efficacy and a randomized controlled trial evaluating the effectiveness in the treatment of the great saphenous vein and its tributaries. Although both thermal and nonthermal techniques cause less pain and allow earlier return to activity and work compared with surgery, there are known complications that are both unique and common and will be the subject of this chapter.