Surgery treatment is the definite way of treatment for the varicose veins. Before the planning of the surgical treatment, operator should know the whole picture of the patients' varicose veins. We have to know exactly which vein is abnormal? Where are the reflux come from? Where the abnormal venous flow drain into? Which vein should we get rid of? Knowing all the pathophysiological changes let surgeons make a precise and effective operative strategy.
One should keep in mind that the when treat the varicose vein surgically, we should permanently removed the varicosities and treat the underlying cause of venous hypertension. In order to do that, we should treat the great saphenous vein carefully, if reflux exists, and watch out for the anatomy variation such as duplication of saphenous veins. in addition to the saphenous reflux, the incompetent perforators should also be treated as well to eliminate the symptoms completely. The fundamental principle of totally removing varicose clusters from the circulation remains firmly established.
Also, we should do the treatment of varicose veins in a fashion as cosmetic as possible. And we should do any effort to minimize the possible complications. That's why so many new developed modalities had been invented in recent years dealing with varicose vein. Methods of accomplishing the treatment have changed and continue to change. Hook phlebectomy and clamp phlebectomy have replaced open dissection and tributary ligation.(1) Small excisions are used for every step of the stripping procedure. Varicose branches are removed with small hooks through incisions of only 1-5 mm in length.(2) The place of tumescent anesthesia, transilluminated-powered phlebectomy, and sclerotherapy also play a role in the treatment.
Other techniques also help to reduce invasivity and to improve the results, such as the endoscopic treatment of perforators, the skin closure with isoelastic adhesive tape and the bloodless operation field by Lofqvist's new roll-on tourniquet. Recent developed radiofrequency ablation and LASER ablation of great saphenous vein also became more and more popular because of the smaller wound, less invasiveness and less hematoma comparing to the traditional stripping procedure. Decreased morbidity and increased patient acceptance is documented.(3) As a vascular surgeon, we should be familiar with those new technique as well.
Operative Planning of Vericose Veins
by Dr. Ko, Po-Jen
Surgery treatment is the definite way of treatment for the varicose veins. Before the planning of the surgical treatment, operator should know the whole picture of the patients' varicose veins. We have to know exactly which vein is abnormal? Where are the reflux come from? Where the abnormal venous flow drain into? Which vein should we get rid of? Knowing all the pathophysiological changes let surgeons make a precise and effective operative strategy.
One should keep in mind that the when treat the varicose vein surgically, we should permanently removed the varicosities and treat the underlying cause of venous hypertension. In order to do that, we should treat the great saphenous vein carefully, if reflux exists, and watch out for the anatomy variation such as duplication of saphenous veins. in addition to the saphenous reflux, the incompetent perforators should also be treated as well to eliminate the symptoms completely. The fundamental principle of totally removing varicose clusters from the circulation remains firmly established.
Also, we should do the treatment of varicose veins in a fashion as cosmetic as possible. And we should do any effort to minimize the possible complications. That's why so many new developed modalities had been invented in recent years dealing with varicose vein. Methods of accomplishing the treatment have changed and continue to change. Hook phlebectomy and clamp phlebectomy have replaced open dissection and tributary ligation.(1) Small excisions are used for every step of the stripping procedure. Varicose branches are removed with small hooks through incisions of only 1-5 mm in length.(2) The place of tumescent anesthesia, transilluminated-powered phlebectomy, and sclerotherapy also play a role in the treatment.
Other techniques also help to reduce invasivity and to improve the results, such as the endoscopic treatment of perforators, the skin closure with isoelastic adhesive tape and the bloodless operation field by Lofqvist's new roll-on tourniquet. Recent developed radiofrequency ablation and LASER ablation of great saphenous vein also became more and more popular because of the smaller wound, less invasiveness and less hematoma comparing to the traditional stripping procedure. Decreased morbidity and increased patient acceptance is documented.(3) As a vascular surgeon, we should be familiar with those new technique as well.