During a stripping procedure, the surgeon makes an incision in your groin and ties off the vein, after which a stripper tool is threaded through the saphenous vein and used to pull the vein out of your leg through a second incision just above your calf.
In endothermal ablation, there is no need for groin surgery. Instead, the vein remains in place and is closed using a special catheter (radiofrequency or laser) inserted through a small puncture. This may eliminate the bruising and pain often associated with vein stripping (i.e., that may result from the tearing of side branch veins while the saphenous vein is pulled out). Vein stripping is usually performed in an operating room, under a general anesthetic, while endothermal ablation is performed on an outpatient basis, typically using local or regional anesthesia.
In studies 1,2,3, both radiofrequency ablation (RFA) and endovenous laser ablation (EVLA) have been shown to be as durable and effective as conventional surgery (stripping) in the treatment of varicose veins, but with a lower incidence of complications from the treatment, and a more rapid return to normal activities.
1 Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, et al. Prospective randomised study of endovenous radiofrequency obliteration (Closure) versus ligation and stripping in a selected patient population (EVOLVES study). J. Vasc Surg. 2003;38:207-14
2 Brittenden J, Cotton SC, Elders A, Ramsay CR, Norrie J, Burr J, et al. A randomised trial comparing treatments for varicose veins. N Engl J Med. 2014; 371: 1218-27
3 Proebstle TM, Alm BJ, Gokeritz O, Wenzel C, Noppeney T, Lebard C, et al. Five-year results from the prospective European multicentre cohort study on radiofrequency segmental thermal ablation for incompetent great saphenous veins. Br. J. Surg. 2015;102: 212-18.