Varicose Vein Surgery

Chronic venous insufficiency (CVI) is a common vascular disorder that affects a significant proportion of the population in the United States and other developed countries. In its advanced stages, CVI significantly reduces patients’ quality of life and imposes a high economic burden on society due to increased direct health care costs and reduced productivity. Favorable clinical results associated with endovascular ablation techniques and patient preference for minimally invasive procedures has led to a shift in which treatment of vein disease is moving from the hospital to the office, allowing a more diverse group of physicians to enter a field that had typically been the domain of surgeons. This chapter reviews the terminology associated with venous disease, indications for varicose vein surgery, preoperative evaluation, procedural planning, endovenous procedures (endovenous laser ablation, radiofrequency ablation), surgical vein stripping techniques, and foam sclerotherapy. Tables include Clinical severity, Etiology or Cause, Anatomy, Pathophysiology classification; summary of nomenclature changes for the lower extremity venous system; indications for varicose vein surgery; interrogation points in the venous reflux examination; complications associated with treatment modalities used in the management of CVI; and methods of variceal ablation. Figures show an ultrasonographic image of a saphenous eye, placement of a quartz fiber for laser ablation of the great saphenous vein, a typical saphenofemoral junction, surgical stripping  of the great saphenous vein, and microfoam sclerotherapy. This review contains 9 figures, 6 tables and 73 references.