Varicose veins--an old dog and some new tricks.

There are many new methods to treat varicose veins being tried and tested around the world, many using patented techniques. They would appear to demonstrate many of the features a military surgeon might deem beneficial for treating a service population, a rapid return to duties amongst them. There are some significant drawbacks. All of these modalities need to offer long-term evidence of efficacy to demonstrate advantage over current standard. The endovenous therapies utilise expensive equipment that limit their introduction and provide a potential for novel complications as well as novel therapy. Modified sclerotherapy as described here has many advantages; it is incredibly cheap, minimally invasive and easily repeatable--in fact planned re-intervention is used in some protocols. Until long-term results are available, it would seem premature to recommend any of these new treatments for use in service personnel with primary varicose veins. Military vascular surgeons will await these results with interest, as the service population would have much to gain from a modality that reliably treats the veins and ensures a swift return to service.