Current treatment of varicose veins

Abstract

Varicose veins (VVs) of the lower limbs are a common complaint that can take many forms, ranging from a nonpathologic condition to an invalidating chronic disorder. When they have not been neglected, uncomplicated VVs have often been treated by sclerotherapy or surgery, with variably successful results. Currently, the best way of assessing VVs has been to carry out routine ultrasound investigations. The approach to VVs has changed due to recent awareness of cosmetic considerations and the way they can affect quality of life, as well as the development of new treatments (ie, echo-guided sclerotherapy, foam sclerotherapy, endovascular obliteration) and ambulatory care practices. In some cases, the evolution of the disease can be disconcerting, if not entirely hopeless. However, in most cases, poor results have been obtained because of perfunctory assessment, inappropriate treatment, and lack of follow-up. The treatment of complicated VVs has been improved by combining clinical and ultrasound examinations, which make for a quick, accurate diagnosis, pointing the way to the right treatment. Venous ulcers resulting from primary saphenous vein insufficiency, which account for 50% of all venous ulcers, and recurrent venous ulcers should all be a thing of the past, apart from those associated with deep valvular insufficiency disease. The quality of care and the scientific standard of clinical studies on chronic venous insufficiency and VVs have both increased considerably. Although there is still a need to set up scales for assessing symptoms and quality of life, progress is being made in clinical studies that now meet the standards of evidence-based medicine.