Start with assessment.
Ultrasound, symptoms, anatomy and personal preferences guide the decision. UFLA and SPOT address particular access and energy-delivery questions; their preliminary evidence does not make them appropriate for everyone.
What options can you discuss?
Options include conservative care such as compression, endovenous thermal or nonthermal ablation, and sclerotherapy or phlebectomy for suitable veins. Each has indications and limitations.
The 2023 SVS/AVF/AVLS guideline favors nonthermal techniques for refluxing distal-calf saphenous veins to avoid thermal nerve injury. Alternative options should be discussed when considering thermal treatment. Preliminary SPOT findings do not supersede this consideration.
Ask more than whether a procedure is possible.
Ask which vein segment would be treated, the expected symptom benefit, possible risks, the size and duration of the evidence base, and reasonable alternatives.
Follow-up remains individualized. Short-term ultrasound occlusion, sensory symptoms and long-term recurrence are different outcomes and should be considered separately.
SVS / AVF / AVLS 2023 clinical practice guidelines, Part II
Source: Yang CC. JVS–CIT. 2026;102274. Limitations Original article
Source: Yang CC. JVS–CIT. 2026;102468. Discussion, Limitations Original article