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INTRODUCTION

The development of minimally invasive methods to heat, denature, and contract varicose veins has been a major achievement in vein treatment and medical science, which began at the start of the 21st century. Endovenous ablation has replaced stripping and ligation, procedures that were first described at the beginning of the 20th century. Over 100 years ago, the Mayo stripper, Babcock stripper device, and Keller device were introduced as surgical instruments for avulsing varicose veins through surgical incisions in the groin and several points along the leg.These strippers are basically wires with an acorn-shaped head that pleats up the vein as it avulses the vessel loose from its attachments. These devices are rarely in use today. The Keller device is an internal wire used to pull the vein through itself, and surprisingly is sometimes still utilized even well into the 21st century as a perforation-invagination (PIN) stripper.

Over the last decade, endovenous occlusion techniques gradually evolved to become accepted as the gold standard. These minimally invasive alternatives to saphenofemoral ligation and/or stripping became adopted as more and more data accumulated indicating safety, efficacy, and successful long-term results.1 The first method of endovenous ablation to replace ligation and stripping was radiofrequency (RF) mediated shrinkage of the vein wall. This replacement for stripping surgery was first developed by dermatologic surgeons, Robert A. Weiss and Mitchel P. Goldman. The initial experience in the United States was published in early 2002.2,3 Critical to success of this Closure™ technique (VNUS Medical Technologies, San Jose, CA) was the application of dermatologic surgical tumescent anesthesia. A detailed discussion of the original endovenous RF ablation technique was included in the first edition of this textbook, the first textbook chapter ever published on endovenous ablation. Most of the world’s literature, however, still attributes development of endovenous ablation to vascular surgeons or interventional radiologists, while many surgeons still cling to the 100-year-old technique of stripping as a gold standard.4

Endovenous RF Closure™ was introduced into clinical practice in Europe in 1998 and in the United States in 1999, cleared by the U.S. Food and Drug Administration (FDA) for marketing in the United States during March 1999. Since then, hundreds of thousands of procedures have been performed worldwide. RF energy is delivered through a specially designed endovenous electrode to accomplish controlled resistive heating of the vessel wall. This causes vein shrinkage or occlusion by contraction of venous wall collagen (VNUS division, Covidien, Mansfield, MA) to eliminate saphenous venous reflux. Although the concept of endovenous elimination of reflux is not new, previous approaches have relied on electrocoagulation of blood. This resulted in thrombus occluding the vein, with the potential for recanalization of thrombus being very high.The concept of application of RF directly to the tissue, rather than blood, has been effectively applied for ablation of abnormal conduction pathways for arrhythmias.5 This concept was conceived for treatment of varicose veins, as venous occlusion with RF by ...

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