Surgical ligation and stripping of refluxing truncal veins was once the standard treatment; however, endovenous ablation technologies have supplanted surgery as the preferred intervention. Furthermore, the application of tumescent anesthesia to the treatment of chronic venous insufficiency has enabled a transition of care from the inpatient to the outpatient setting.

Endovenous Laser Ablation (EVLA) and radiofrequency ablation (RFA) are the endothermal modalities, and they use thermal energy to effect fibrosis and sclerosis of the vein wall. Data demonstrates improved efficacy and reduced complication rates with EVLA and RFA as compared to surgical stripping. Non-thermal, non-tumescent technologies have recently come to the market and are gaining traction. These include mechanicochemical ablation (MOCA) and adhesive closure.

Sclerotherapy uses a sclerosing agent to make contact with the vein wall in order to cause endothelial damage. Although efficacious for the treatment of telangiectasias and reticular veins, treatment of truncal veins with sclerotherapy is met with variable efficacy as compared to the endothermal technologies.