Synopsis
Choose between endothermal ablation, ultrasound-guided foam sclerotherapy and surgery for truncal venous reflux, while recognising procedural limitations and complications.
- Confirm symptomatic truncal reflux with duplex before intervention; identify the refluxing target, deep-vein patency and anatomy that may make superficial ablation unsafe or ineffective.
- For confirmed truncal reflux, NICE offers endothermal ablation first, ultrasound-guided foam sclerotherapy if endothermal treatment is unsuitable, and surgery if foam is unsuitable.
- Explain that treatment may require more than one session, new or recurrent veins can develop, and post-procedure DVT or PE symptoms require urgent assessment.
Key red flags
Sudden dyspnoea, chest pain, haemoptysis, collapse or marked unilateral swelling after treatment needs urgent assessment for venous thromboembolism.
A cold painful foot, neurological deficit, severe escalating limb pain or tissue discoloration raises concern for arterial injury, compartment syndrome or major extravasation.
After foam injection, an acute focal neurological deficit, seizure, persistent visual loss or altered consciousness requires emergency neurological assessment rather than reassurance as migraine.
Fever, spreading erythema, purulent discharge or systemic illness after an incision or puncture suggests infection and requires prompt clinical review.
Investigation priorities
Confirm the reflux source, map truncal and tributary anatomy, and establish deep-vein patency before treatment.
Management branches
Use after specialist clinical assessment and duplex have demonstrated a refluxing superficial trunk that explains symptoms or complications.
- Offer endothermal ablation when the target can be accessed and treated safely, explaining catheter placement, tumescent anaesthesia, expected discomfort and alternatives.
- If endothermal treatment is unsuitable, consider ultrasound-guided foam after checking product contraindications and counselling about pigmentation, phlebitis, VTE, visual and neurological effects.
Use when a suitable refluxing great or small saphenous segment makes catheter-based thermal closure the preferred agreed procedure.