A NICE Introduction to EndoThermal Ablation

The United Kingdom’s National Institute for Health and Care Excellence (NICE) has updated their guidelines for the treatment, diagnosis, and management of varicose veins. For the first time, NICE recommends heat ablation therapy as a first-line treatment instead of more invasive surgical procedures.

Contrary to what the UK’s National Health Services and many insurance companies have stated before, the new NICE guidelines have recommended that all people with symptomatic primary or recurrent varicose veins should be referred to a vascular specialist for assessment and treatment, instead of directed to the OR. The NICE guidelines also state compression stockings should not be offered to treat varicose veins or even delay their evaluation/treatment, unless interventional treatment is unsuitable. This important distinction brings with it a new era in the management varicose veins—creating a more easily-accessible, outpatient environment whereby patients can receive same day procedures requiring only local anesthetic and allowing them to return to normal activities that same day.

Guidelines for Endothermal Ablation

These NICE guidelines advise the usage of endothermal ablation which includes endovascular laser and radiofrequency treatment—as the recommended first option in treating varicose veins. Varicose veins affect more than 3 in 10 adults in the UK, similar to the prevalence here in the United States. Varicose vein disease (venous insufficiency) was found to impact patients’ quality of life on a scale comparable to that of either congestive heart failure or chronic lung disease. Additionally, the burden to the National Health Service of managing the impact of untreated varicose veins (that can result in leg ulcers) is estimated at billions of dollars annually. Heat ablation, they concluded, is a cheaper therapy associated with less pain and quicker recovery times for patients, compared to the significantly more invasive formerly traditional surgeries such as vein stripping or ligation. In sum, access to appropriate vein treatment can transform patients’ lives.

Symptoms of venous insufficiency, the underlying cause of varicose vein disease, include pain, swelling, aching, heaviness, itching, restless leg syndrome, cramping, and skin discoloration. Usually these symptoms worsen as the day progresses or with activities such as prolonged standing or sitting—often required by certain occupations. While these symptoms may start out mild, they can quickly progress in severity if left untreated—resulting in immeasurable discomfort for its sufferers which drastically affects the quality of their lives.