The option of saphenous vein treatment is considered when colour Doppler ultrasound documents clinically significant great or small saphenous vein reflux associated with symptoms, varicose veins, skin changes, superficial thrombophlebitis or a venous ulcer. Reflux alone does not automatically require a procedure: the indication and technique must be individualised.
At Centro Medico Gargano in Naples, endovenous radiofrequency, ultrasound-guided sclerosant foam or other options are chosen after a phlebology consultation and venous colour Doppler ultrasound with anatomical and haemodynamic assessment.
When treating the saphenous vein may be indicated
Assessment is particularly relevant in the presence of:
- symptomatic or recurrent varicose veins;
- heaviness, pain, itching or swelling attributable to venous insufficiency;
- pigmentation, eczema or skin hardening of venous origin;
- superficial venous thrombosis associated with venous incompetence;
- an active or healed venous ulcer;
- bleeding varicose veins.
Leg symptoms are not always caused by the saphenous vein. Lymphatic, musculoskeletal, neurological or systemic causes should be excluded before attributing pain or swelling to venous reflux.
Why colour Doppler ultrasound is essential
The examination confirms the presence and extent of reflux and assesses the deep and superficial systems, saphenous diameter, depth and course, varicose tributaries, perforators and any consequences of previous thrombosis. This information allows planning of the procedure and identifies situations in which a technique may be less suitable.
Endovenous radiofrequency
Radiofrequency is a thermal endovenous technique. A catheter is introduced into the saphenous vein under ultrasound guidance, and thermal energy produces controlled closure of the treated segment. The procedure is generally performed under tumescent local anaesthesia without a conventional inpatient stay.
When anatomy is favourable, guidelines consider thermal endovenous ablation a first-line choice for truncal reflux requiring treatment. This does not mean it is always the best solution: very superficial or tortuous veins, short segments, previous procedures, proximity to nerves or other characteristics may favour alternatives.
Discomfort, bruising, tightness or hardening along the vein may occur during and after treatment. Less frequently, superficial phlebitis, altered sensation, skin burns or venous thrombosis are possible. Return to activity is often quick but varies with the procedure, type of work and individual response.
Ultrasound-guided sclerosant foam
The sclerosant foam is injected into the target vein under ultrasound control. The medicine causes a reaction in the vein wall that may close the segment. The procedure is percutaneous and does not require a thermal catheter along the entire length.
It may be useful when thermal ablation is unsuitable, with tortuous anatomy, in some recurrent cases or when selective treatment of the saphenous vein and tributaries is appropriate. The VARIXIO system standardises foam preparation but does not replace the clinical indication or guarantee the result.
After sclerotherapy, hardening, local pain, superficial phlebitis, pigmentation, new small spider veins and recanalisation may occur. Thrombotic, allergic or neurological events are less common but should be considered when informing and selecting patients.
Radiofrequency or foam: how the decision is made
The choice takes account of:
- saphenous vein diameter, depth and tortuosity;
- the length of the incompetent segment;
- the distribution of varicose tributaries;
- previous procedures or recurrence;
- thrombotic risk, comorbidities and current treatments;
- the patient’s goals and preferences after receiving full information.
According to NICE, thermal endovenous ablation is offered for varicose veins with confirmed truncal reflux when suitable. If it is inappropriate, ultrasound-guided foam is considered; if that is also unsuitable, surgery is considered. European guidelines likewise emphasise adapting the technique to anatomy and the clinical findings.
What about varicose tributaries?
Closing the saphenous vein does not necessarily remove all visible varicose veins. Tributaries may be treated at the same appointment or later with sclerotherapy, ambulatory phlebectomy or another appropriate technique. The strategy depends on the ultrasound map and changes after treating the main reflux.
Follow-up and results
Clinical and ultrasound follow-up checks vein closure, the deep system and any need to treat residual segments or tributaries. No method can guarantee freedom from recanalisation, new varicose veins or further procedures over time.
Frequently asked questions
Must an incompetent saphenous vein always be closed?
No. The indication depends on symptoms, clinical signs, reflux extent, disease progression and informed preferences. An isolated ultrasound finding is not enough.
Is treatment painless?
This cannot be promised. Local anaesthesia and minimally invasive techniques reduce discomfort, but needle sensations, burning, tightness, pain or hardening may occur during or after the procedure.
Can activities be resumed immediately?
Many patients resume normal activities soon, but timing and restrictions depend on the technique, treatment extent, type of work and instructions received.
Sources and further reading
- NICE: Varicose veins — diagnosis and management.
- ESVS 2022 Clinical Practice Guidelines on chronic venous disease of the lower limbs.
For a general overview, see the page about varicose veins in Naples. For the address and access to the clinic, see Contact and directions.
