Endovenous laser ablation of tributary varicose veins: A literature review and recent initiatives in Japan

BackgroundEndovenous laser ablation (EVLA) has become a standard treatment for saphenous trunk reflux. However, its application to tributary varicose veins-referred to as varicose vein ablation (VVA)-has not been well recognized. Early reports using bare-tip fibers were associated with relatively high rates of postoperative complications, including skin burns and nerve injuries, which limited worldwide acceptance of this approach.MethodsThis narrative review summarizes 14 relevant publications, including a recent Japanese multicenter study and guideline development initiatives. Particular attention is given to the introduction of a 1470-nm radial 2-ring slim fiber (R2SF), its technical characteristics, and nationwide clinical experience in Japan. Educational and certification programs initiated by the Japanese Society of Phlebology are also reviewed.ResultsThe R2SF enables uniform endovenous laser ablation via a 16-G venous needle without skin incisions. A Japanese multicenter study involving 400 cases demonstrated complete vein occlusion at 1 month in all treated veins, with no severe complications. Based on accumulating clinical data, the 2025 Japanese guidelines recognized VVA as the third treatment option alongside stab avulsion and sclerotherapy. The author's experience of over 1700 cases further supports low complication rates and favorable cosmetic outcomes. Transient subdermal induration is relatively common but resolves spontaneously without infection or skin damage.ConclusionsVVA using an R2SF represents a safe, minimally invasive, and incision-free approach for treating tributary varicose veins. The Japanese experience, supported by guideline endorsement and national training systems, suggests that VVA may complement some limitations of stab avulsion. Long-term observation and international validation are necessary.