As of February 2018, is VenaSeal or EVLT the better choice for treating leaky GSV?

With advances in technology we are now able to offer several different options to our patients who need to have a vein closed.  EVLT has a very well established track record as well as an excellent long-term success rate.  EVLT does involve an extra step of injecting numbing medicine around the saphenous vein which leads to some discomfort for most people as well as about three to five extra needle sticks.  VenaSeal is relatively new and closes the veins down without any heat.  For this reason, you do not have to numb the vein up and you will only feel the one stick where the doctor inserts the device.  That being said, both procedures work very well, if you have a needle phobia, VenaSeal may be the way to go, otherwise, I'd probably lean towards EVLT.

EVLT has been around a long time, with a lot of research showing very durable long term results.  In addition, a similar procedure using radiofrequency (RF) energy also has similar excellent results.  I personally prefer the ClosureFast procedure, which uses RF, and is also made by Medtronic now (like VenaSeal).  Data shows it results in less bruising and discomfort, and people have slightly less downtime with it versus EVLT.  That being said, the differences are small, and both procedures work well.  
I personally am not sold on VenaSeal yet.  I know they now have a CPT code, but I didn't know medicare was covering it yet.  Another option is ClariVein, which doesn't require the tumescent anesthesia that EVLT or ClosureFast do.  This typically results in a faster procedure, and in our area Medicare does cover it as well.  

Venaseal is newer.  Newer is not always better.  Newer is sometimes just newer.  There is not long term data on Venaseal.  Endovenous laser ablation and Venaseal are both done in the office.  Both take only around 20 to 30 minutes to do. ENdovenous laser has been around for almost 20 years and Venaseal is relatively new.  I would say that the best treatment is the one your doctor recommends for you, your insurance covers and the one you feel most comfortable having.  

First of all, make sure that you have a doctor you trust, someone who has answered your questions and is knowledgeable about your condition. Just because a vein is large, does not necessarily mean that it is broken (venous insufficiency) or that fixing it will make you feel better. Ask your doctor (not the PA, not the tech - the doctor who is going to do your procedure), what they recommend and why. Both techniques offer excellent treatment for something that once required vein stripping surgery, so they are both better options. VenaSeal is newer but that doesn't mean it is better. If someone tells you the procedure will be marginally more comfortable, remember that the procedure lasts 30 minutes but you need to have your legs working properly forever. Make sure your particular doctor thinks one or the other is better and why.