Endovascular Techniques

Forerunner of endovascular techniques for treatment of the varicose saphena was Gaetano Conti from Naples, who, in 1854, proposed a complex method based upon "electro-puncture and cauterizations of varicose veins" (see Figure 1.16). Modern endovascular techniques started in 1964 with Werner and McPheeters ("electrofulguration") and Politowski ("endovenous electrosurgical dessication"). A similar technique was proposed by Watts (1972) to treat saphenous varicosities by endovenous diathermy. In 1981, a freezing technique was proposed by Milleret and Le-Pivert to treat saphenous trunk insufficiency. This technique was refined in 1997 by Constantin, who associated ligation and division of the saphenous junction with saphenous trunk removal by a cryoprobe. The field of physical schlerother-apy was drastically revolutionized by two innovative techniques, which obtained the obliteration of the varicose trunks by endovascular radiofrequency and laser. Endovascular radiofrequency diffused in the late 1990s, and the first positive results were reported by Mitchell Goldman in 2000. The use of endovenous laser in the treatment of the varicose saphena was proposed first by Puglisi at the IUP World Congress of 1989 held in Strasbourg. Endovenous laser technique was deeply refined and worldwide diffused in 1999 by Bone. Many centers are still at work to evaluate exact indications and results of these techniques.

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