In recent years, minimally invasive methods for the treatment of varicose veins (VVs) have been established as the first method of choice because of their advantages and high success rates. The most widely applied ones are endovenous thermal ablation (EVTA)—laser, radiofrequency, and microwave; mechanochemical ablation (MOCA); cyanoacrylate embolization (CAE); sclerotherapy, and ambulatory micro phlebectomy. With EVTA, a thermal effect on the wall of the affected vein is achieved through an endovenous catheter, leading to fibrosis and obliteration. EVTA is conducted under tumescent anesthesia. MOCA and CAE are nonthermal, nontumescent methods for obliteration of insufficient and varicose veins. MOCA combines chemical with mechanical damage to the intima of a venous vessel. CAC is a method consisting of the application of cyanoacrylate glue into the lumen of the affected vein, causing total obliteration. Sclerotherapy represents the chemical ablation of varicose veins by injecting a sclerosing agent into the vein. Ambulatory micro phlebectomy is performed through microincisions with specially designed hooks and mosquito-clamps under local anesthesia and does not require skin sutures. In aesthetic phlebology a combined method is used to treat reticular veins and telangiectasia— cryo-laser & cryo-sclerotherapy (CLaCS), which includes transdermal laser and sclerotherapy with dextrose, as well as cooling. In European and US recommendations for the treatment of chronic venous disease, EVTA is indicated as the first choice in the treatment of VV. Sclerotherapy and ambulatory micro phlebectomy are used to eliminate residual and recurrent varicose veins and in cases of absence of axial reflux. MOCA and CAC are the second choice methods.
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