Surgical treatment of initial forms of varicose veins of the lower extremities

Experience in the treatment of 386 patients with stage 2-3 of varicose disease is analyzed. There are five main variants of surgical treatment in these patients: combined phlebectomy, sclero-obliteration of the trunk, short stripping with ligation of insufficient perforant veins, short stripping with excision or destruction of varicose branches, short stripping and sclero-obliteration of the trunk. It is demonstrated that minimally invasive surgical procedures decrease the number of postoperative subcutaneous haematomas, ensure good cosmetic effect, allow to avoid an injury of n.saphenus and lymphorrhea. It is concluded that minimally invasive surgical procedures may be used for treatment of initial forms of varicose disease.     

Injection treatment of varicose veins

From a considerable study of the literature, and from my own experience, I am convinced that the injection treatment of varicose veins is the best and most successful treatment for this condition which we have at our disposal today. It has the additional advantage of being purely an office procedure and of causing no interruption to the patient's usual routine; consequently it deserves to be widely employed. In this short paper, I have not attempted to be exhaustive; I have merely tried to describe a technic for administering these injections which I have found to be simple and practical, and which, with ordinary care and attention to detail, can be readily utilized by any physician interested in doing this work.     

Endovascular treatment of varicose veins

Within the past 5 years, radiofrequency ablation and endovenous laser treatment have been introduced as important new endovenous ablative techniques for the minimally invasive treatment of superficial venous reflux and varicose veins. Although sclerotherapy has been a well-established technique for spider telangectasia, recent reports have documented that administration of aerated or foamed sclerosants provides an excellent cost-effective option for treatment of varicose veins. This report reviews the indications for these minimally invasive techniques, the technical aspects of these approaches, and describes in detail the short and long-term success rates. To date, results of minimally invasive therapies are equivalent to or surpass those of surgical vein stripping, while offering dramatically reduced recovery time and complication rates.     

Endovenous laser treatment of varicose veins

Endovenous laser treatment (EVLT) has become a standard therapy for the treatment of superficial venous insufficiency. It offers a rapid, office-based therapy with minimal patient downtime and an easier recovery than traditional surgical treatment. EVLT is effective and durable and can successfully treat saphenous truncal insufficiency and accessory branches with low complication rates. EVLT can increase patient satisfaction and enable the treatment of a wider variety of patients with a more efficient procedure compared with traditional techniques.     

Autovenous obturation of subcutaneous veins in surgical treatment of varicose disease

753 patients were operated on varicose veins of lower limbs in the period from 1997 to 2006 years. Autovenous obturation of the shin and backfoot varicose veins was performed in all cases. Bands of great saphenous vein, extracted from the patient's hip, were used as an obturation material. 7 (0,9%) patients developed wound inflammation postoperatively. After removal of the saphenous graft, the inflammation had rapidly diminished and the wound healed by primary intention. The authors declare, that the use of varicose veins obturation with an autovenous graft during the combined phlebectomy favours a considerable improvement of direct and follow-up results of the operation.     

Embolisation of symptomatic pelvic veins in women presenting with non-saphenous varicose veins of pelvic origin - three-year follow-up.

AIM: To evaluate the clinical results of embolisation of symptomatic, incompetent pelvic veins in women presenting with perineal veins. PATIENTS AND METHODS: Twenty-four women presenting with non-saphenous perineal varicose veins and who experienced pelvic vein syndrome were treated. Symptoms was scored on a visual analogue scale assessing dyspareunia, pelvic and lower limb pain. Lower limb varices were investigated by duplex ultrasonography. Pelvic veins were studied by pelvic vein angiography with simultaneous embolisation of incompetent veins. Ovarian and internal iliac veins were systematically embolised when incompetent. Follow-up assessment of symptoms and varices was carried out at 1, 2 and 3 years. RESULTS: All patients presented with perineal veins, 2 with sciatic vein incompetence and 2 with a perforator of the thigh or buttock. Pelvic venous angiography was performed via right femoral access in 87% of the cases and confirmed the presence of incompetent ovarian and internal iliac veins. The mean number of coils used per vein was 6 and all were successfully embolised. No serious complications were encountered. The mean clinical improvement score was 80%, 77%, 80% and 76% at respectively 45 days, 1, 2 and 3-year follow-up. CONCLUSION: In women of reproductive age, non-saphenous varicose veins associated with pelvic venous incompetence (PVI) should undergo pelvic vein investigation. In this clinical series we achieved a satisfactory improvement in symptoms after 3 years following treatment of incompetent pelvic veins.