A synopsis of current international guidelines and new modalities for the treatment of varicose veins.

BACKGROUND The UK National Institute for Health and Care Excellence released new guidelines in 2013 recommending that endovenous thermal ablation (laser or radiofrequency) and ultrasound-guided foam sclerotherapy should be offered before conventional surgery for treat-ment of varicose veins and saphenous vein reflux. OBJECTIVE The aim of this article is to provide a synopsis of current international guidelines and recent advances for the treatment of varicose veins. DISCUSSION Conventional surgery involving classical high ligation and stripping of the saphenous vein has been standard practice for nearly a century. Surgery requires general anaesthesia and hospitalisation, and there is a high rate of recurrent disease. In the past decade there has been an international trend where the minimally invasive techniques of endovenous thermal ablation and ultrasound-guided foam sclerotherapy, which do not require hospitalisation, are beginning to displace surgery. These changes in technique have been supported by recently published international guidelines.