The veins

Varicose veins of the legs are among the most common adult medical problems, especially forthe female population. It is believed that almost 40% of the female population over 30 years of age has expressed varicose veins in the legs. The first surviving descriptions of varicose veins date back to ancient Greece. From then, until now, the development of medicine has led to the knowledge of the causes of varicose veins and toits treatment procedures.

Varicose veins of the legs are not just a cosmetic problem. Problems that they can cause, including leg swelling, leg pain, phlebitis, variceal hemorrhage, and prolonged untreated varicose veins, can lead to changes in the skin and subcutaneous tissue, usually the lower leg. This can lead to brownish skin pigmentation, thinning of the skin, and ulcerations that are at risk of recurrence. All these possible complications are the reason that varicose veins should be treated as soon as possible, even more so as a positive aesthetic effect of treatment. It should be noted that the subjective symptoms that cause varicose veins need not be proportional to the clinical findings.

To treat varicose veins successfully, a detailed clinical examination of the patient is required, which includes not only an overview of leg veins but a complete vascular (arterial and venous) status. Other possible health problems that the patient may have also need to be taken into account. For example, a patient who, in addition to varicose veins has an arterial defficiency in the legsmay require different treatment to a person with regular arterial circulation in the legs.

Taking a detailed history and physical examination is the first step to proper treatment. The next step is detailed ‘Doppler’of the leg veins, which can be used to determinethe changes in the venous system underlying varicose veins. Only after such a procedure, a treatment plancan be made.

Treatment of varicose veins

Modern medicine offers several methods of treating varicose veins. Still the most widely used method of healing that is practiced in most of the surgical clinics in Croatia, is the classic surgical treatment. From a long term perspective, it is a method that gives excellent results compared to all other methods. Disadvantages of conventional surgical treatment are primarily the prolonged post-operative recovery. In developed countries, over the past few years, the classic surgical treatment has been largely replaced by treatment with radio frequency waves and laser. Results of such treatment are comparable to the results of traditional surgical treatment, in which the procedure is less invasive, and the recovery is faster. As an alternative to conventional surgical treatment and treatment with radio frequency waves and a laser, sclerotherapy has been increasingly used. By this, we mean foam sclerotherapy, which gives excellent results if the diagnosis is made properly.Unfortunately, the relatively simple technique of foam sclerotherapy did not result in a wide application of this method of treatment. On one hand, untrained and unprofessional people started performing sclerotherapy; on the other, sclerotherapy began to be applied in cases which were not medically prescribed. Applying the principles of evidence-based medicine, on the basis of all current knowledge about treating veins, in 2011 the Society for Vascular Surgery and the American Venous Forum, published “The recommendations on the treatment of varicose veins”. Thus, for the treatment of telangiectasia, reticular veins, and varicose veins, sclerotherapy is recommended by using liquid or foam, while the treatment of insufficiency of magnasaphenous vein (VSM) saphenous vein parva (VSP), thermal (radiofrequency or laser) ablation isrecommended. In such cases, sclerotherapy can be a complementary treatment to be made in a way that after the thermal ablation of veins,the remainingvaricose veins are treated by sclerotheraphy. Compression therapy is recommended after completion of thermal ablation and / or sclerotherapy.

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