A comparison of thermal and non-thermal ablation

Varicose vein disease is common and has an adverse effect on patients. Treatment of the condition has been demonstrated to improve patients' physical well-being and quality of life. Surgical treatment has for a long time been the ‘gold standard’ method until the launch of endovenous thermal ablation towards end of the twentieth century. Indeed, being less invasive and offering the possibility of day-case local anaesthetic procedures, they have gradually become the mainstay of contemporary varicose vein treatment. Vein ablation using steam and microwave are new additions to thermal methods, but there is currently insufficient evidence as to their effectiveness and place in the management of varicose veins. The superiority of thermal ablation is now being challenged by endovenous non-thermal methods. Foam sclerotherapy, until recently the only endovenous non-thermal technique available, has been joined by mechanochemical ablation and cyanoacrylate glue as viable alternatives to thermal ablation. It is believed that these new non-thermal methods will be able to offer additional benefits to patients. This review of thermal and non-thermal ablation techniques assesses their respective merit in the management of varicose veins.