Varicose veins of lower extremities, hemodynamics and treatment methods.
Chronic venous insufficiency is one of the most common disorders of the vascular system, affecting approximately 50% of adults. If left untreated it can lead to a number of complications, including venous ulceration and venous thrombosis. This review paper outlines the epidemiology and ethiopathogenesis of the disease with regard to hemodynamics and microcirculation disturbances. It describes the medical treatment as well as the traditional surgical approach to varicose veins (with several modifications of this technique), and its limitations and contraindications. Furthermore, it discusses a number of new, minimally invasive treatment methods, namely thermal in form (radiofrequency ablation, endovenous laser ablation, steam ablation) and nonthermal (sclerotherapy, echosclerotherapy, Clarivein, Sapheon). For each method, there is a brief historical overview, a description of its mechanism of action, and its indications and limitations. The results of comparative studies on individual treatment methods as well as meta-analyses on this topic are briefly discussed. This paper highlights the progressive trend towards minimally invasive methods and attempts to predict the further development.
Clinical Department of Vascular Surgery, University Hospital, Kraków, Poland.
Maciej
M
Chwała
Allergy and Immunology Clinic, University Hospital, Jagiellonian University Medical College, Kraków, Poland.
Wojciech
W
Szczeklik
Department of Cardiothoracic Surgery, London Chest Hospital, London, United Kingdom.
Michał
M
Szczeklik
Vascular Surgery Medical Centre, Kraków, Poland.
Tomasz
T
Aleksiejew-Kleszczyński
Vascular Centre, St. John Grande Hospital, Kraków, Poland.
Maria
M
Jagielska-Chwała
D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods; D006439:Hemodynamics / Q000187:drug effects / Q000528:radiation effects*; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation / Q000379:methods; D035002:Lower Extremity / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy / Q000295:instrumentation / Q000379:methods; D014648:Varicose Veins / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D014689:Venous Insufficiency / Q000473:pathology / Q000601:surgery* / Q000628:therapy
D012597:Sclerosing Solutions