الفهرس 
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Abstract
Varicose veins are tortuous, widened veins in the subcutaneous tissues of the legs and are often easily visible. Varicose veins of the legs affect approximately 25% of the population.
A normal venous system depends on the integrity of valves, vein wall and the hemodynamics of venous blood flow. Normally the venous flow is a unidirectional and cephalad flow from the superficial veins through the perforators and into the deep system. In varicose veins this flow is disrupted resulting in stasis and venous hypertension.
Recently it has been suggested that valvular incompetence is secondary to vein wall dilatation. Venous dilatation can develop below the valves. Reflux in saphenous system can proceed in an ascending fashion. This is the ascending valvular incompetence theory.
Several predisposing factors are thought to contribute in the formation of varicose veins. Family history, age, gender and pregnancy are the most important.
Although varicose veins have traditionally been regarded as simply a cosmetic problem more commonly they produce symptoms of heaviness, fatigue, pain, swelling, restlessness, burning and pruritus which interfere with activities of daily living and result in lost time from work. About 10% of people with varicose veins go on to develop skin changes such as pigmentation or eczema while about 3% may develop venous ulcers.
Although varicose veins are common many remain asymptomatic and only a minority present for treatment. In addition to improving cosmetic appearance current treatments for varicose veins are aimed at reducing venous hypertension and the resultant chronic inflammation that leads to ulceration.
Duplex scanning is recommended as the first diagnostic test for all patients with varicose veins. It is safe, noninvasive, cost-effective, and reliable.
Treatment options include conservative measures (lifestyle modification, medications, and compression therapy) and if these are unsuccessful surgical and more recently endovascular procedures in which the vein is removed, ligated or sclerosed. These treatments may be used alone or in combination to improve the appearance and the lifestyle-limiting manifestations of varicose veins.
The various surgical procedures that are currently or have traditionally been used to treat varicose veins of the lower limbs are high ligation of saphenous vein, high ligation with “external” stripping of saphenous vein. high ligation with “invagination” stripping of saphenous vein, ambulatory phlebectomy, transilluminated Powered Phlebectomy (Trivex), saphenous sparing operations, perforator avulsion/ligation and Subfascial endoscopic perforator surgery (SEPS).
Endovenous procedure in general has gained approval due to their minimally invasive nature, excellent outcome, good long term results, early walking and return to work. Endovenous thermal ablation can be performed using Radiofrequency Ablation (RFA). RFA operates by resistive heating of the vein wall in its whole circumference causing endovenous temperatures of 85-90°C.
New modalities as radiofreqency ablations are better than surgical procedure in treatment of varicose veins as their minimally invasive procedure with less complications. Its potential early benefits, by avoiding groin dissection and GSV stripping. Patients experienced less pain and recovered more quickly, which was reflected in better patient satisfaction and quality of life outcomes following RFA. This improved confidence, lifestyle, social contacts, cosmoses, QoL and satisfaction in the early days after the procedure.