Abstract
Varicose veins, often thought as a purely cosmetic issue, are a common symptom resulting from chronic venous insufficiency (CVI). CVI can result in serious fasciocutaneous and haematological complications. In 2013, NICE recommended that the treatment of varicose veins should preferably be carried out by endothermal ablation (ETA). The mechanism of action of ETA is still not fully understood. In 2004 it was suggested that successful treatment must involve transmural vein wall death (TMVD) in the target vein. Through the development of a novel in-vitro¬ model, using ex-vivo veins, the work carried out in this thesis has indicated that TMVD is reliant on a combination of thermal necrosis, followed by the upregulation of apoptosis. The novel model has been used to compare four different ETA techniques; endovenous laser ablation (EVLA) using an 810nm endovenous laser (EVL) with a jacketed fibre, EVLA using a 1470nm EVL with a jacketed fibre, EVLA using a 1470nm EVL with a radial fibre and Radiofrequency-induced Thermo Therapy (RFiTT). The comparisons indicate that treatment with the 810nm EVL is inferior at causing TMVD, in comparison to the 1470nm EVL. Treatment with a radial fibre, compared to a jacketed fibre, when using a 1470nm EVL, shows an improved damage profile that is much more homogenous with less overtreatment of target tissue. Comparisons between RFiTT and EVLA, indicate that treatment with RFiTT is as effective at causing TMVD as the 1470nm EVL with a radial fibre but with differences in the thermal damage profile. These results correlate well with reports from the current literature. However, this novel model has been able to show that the upregulation of apoptosis plays a pivotal role in TMVD after ETA treatment. The results also show that histology is often not sufficient to alone determine the difference between successful and inadequate treatment.