o what are varicose veins from a medical point of view?
Dr. Salama: The term "varicose veins" traditionally refers to bulging veins that are usually visible on the legs when standing. Today, the term is used to describe dilated veins as well as the underlying incompetent veins that back up and cause the aboveﬂ surface varicose veins. Varicose veins are used to describe an oberﬂächlichen venous Rückﬂuss, even if no dilated veins are visible.
What are the methods of examination of varicose veins?
Dr. Salama: Varicose veins usually worsen and lead to discomfort, swollen ankles, skin damage, leg ulcers, superﬂicial venous thrombosis and venous bleeding. Most often, the cause is venous reﬂux from saphenous, perforating, or local supply veins, so venous duplex examination should be mandatory before treatment. The best method for examining varicose veins on the legs is venous duplex ultrasound in the upright position, performed by a specialist trained in ultrasonography.
The Reﬂux of the pelvic veins is best examined with transvaginal duplex ultrasound (TVS), which is performed according to a special protocol. In men or women in whom TVS cannot be performed, venography or cross-sectional examination is required.
What are the treatment methods for varicose veins in the practice?
Dr. Salama: The best method for the treatment of truncal venous insufﬁciency is endovenous ermoablation. Many physicians who use endovenous procedures have merely replaced stripping with an endovenous procedure without realizing that the entire approach to treating varicose veins has changed and our understanding of the underlying pathophysiology has improved significantly. Therefore, simply replacing stripping with endovenous treatment is unlikely to result in optimal long-term outcomes. Achieving the best possible outcomes requires a comprehensive understanding of the underlying pathophysiology and the use of targeted treatments based on current research. The treatment of varicose veins, chronic venous insuﬃzienz, should be based on hemodynamic principles. The planned therapeutic strategy is to reliably eliminate the reﬂux of the great saphenous vein and prevent the pathological abﬂuss of venous blood at the knee level.
How should perforater veins be treated in practice?
Dr. Salama: There is increasing evidence that signiﬁcant incompetent perforater veins should be found and treated by thermal ablation using transluminal perforator occlusion (TRLOP), and that incompetent iliac veins that drain into symptomatic varicose veins in the genital area or legs should be treated by coil embolization. Extensive varices should be treated by phlebectomy at the time of truncal vein ablation. Various methods of foam sclerotherapy can be used for this purpose.
What is currently the best treatment method?
Dr. Salama: Monitoring and reporting of results and follow-up is essential for physicians and patients. Therefore, a vein registry should be mandatory.
At LBCL Surgery & Vein Practice, we follow a strict, thorough follow-up plan within 28 days of primary treatment and optionally up to 18 months postoperatively. Beginning in 2023, we will participate in the College of Phlebology's Vein Registry, which will bring our standards to a high international level based on the latest research and best practices in evidence-based medicine.