Modern methods of surgical treatment for lower limb varicose vein disease (literature review)
AbstractBackground. Numerous large-scale studies on the etiology and pathogenesis of lower limb varicose vein disease have been conducted, forming the basis for modern preventive and therapeutic approaches. In recent years, there has been a steady shift from traditional open surgical interventions to minimally invasive endovenous and non-thermal techniques, aimed at reducing treatment trauma, decreasing complication rates, and improving aesthetic outcomes. One of these methods is a modified laser coagulation technique for tortuous tributaries, known as skewer obliteration.
Objective. To evaluate the effectiveness of modern surgical methods for treating varicose veins of the lower extremities and the frequency of complications associated with their use.
Materials and methods. A review of domestic and foreign literature published over the past five years was conducted using PubMed, eLibrary and CyberLeninka databases with the query: “modern/innovative methods/treatment of varicose veins of the lower extremities.” A total of 1281 publications were identified at the initial search stage. After excluding duplicates, irrelevant works, and sources with low evidence levels, 51 publications were included in the final analysis. Key assessment criteria included treatment effectiveness, complication rates, severity of postoperative pain, cosmetic outcomes, and recurrence rates.
Results. According to the literature analysis, there is a consistent increase in the use of minimally invasive technologies. Thermal methods such as endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) demonstrate stable occlusion of major veins in 93–98% of cases one year after treatment, with a low incidence of serious complications (0.5–3%). Non-thermal methods (cyanoacrylate and mechanochemical ablation) are associated with less postoperative pain and do not require tumescent anesthesia; however, they may lead to specific hypersensitivity reactions in up to 13% of cases. Techniques for removing tortuous tributary veins (miniphlebectomy, sclerotherapy) remain effective but increase the risk of hematomas (up to 50%) and hyperpigmentation (up to 42%). Current trends in phlebology include laser coagulation of saphenous vein tributaries, specifically the modified skewer-obliteration technique. This technology enables the obliteration of tributaries through a minimal number of skin punctures, thereby reducing tissue trauma and ensuring a superior cosmetic outcome. Given the current lack of comparative studies with alternative treatments and the absence of long-term data required for an objective efficacy assessment, this area of research remains highly promising.
Conclusion. Minimally invasive methods for treating varicose vein disease demonstrate high effectiveness and low complication rates compared with traditional interventions and can be recommended as standard therapeutic approaches. The skewer-obliteration technique represents a promising direction that requires further prospective studies with long-term follow-up.
Keywords:varicose veins; endovenous laser ablation; radiofrequency ablation; non-thermal non-tumescent methods; miniphlebectomy; sclerotherapy; skewer obliteration
Author’s contribution. Study conception and design – Figurkina M.A., Derkachev S.N., Kobzar I.G., Selimov Sh.V., Suchkov I.A.; data collection and handling – Figurkina M.A., Derkachev S.N.; draft manuscript preparation – Figurkina M.A; manuscript revision – Derkachev S.N., Suchkov I.A.
For citation: Figurkina M.A., Derkachev S.N., Selimov Sh.V., Kobzar I.G., Suchkov I.A. Modern methods of surgical treatment for lower limb varicose vein disease (literature review). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2026; 32 (3): 113–25. DOI: https://doi.org/10.33029/1027-6661-2026-32-3-113-125
Dear readers!
Full-text version of the article is available only in paper version.