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Are venous insufficiency and varicose veins just a matter of aesthetics?

Venous insufficiency (“phlebitis”) is not just “unsightly varicose veins” as some (even health professionals) mistakenly believe, and that is why we observe low interest in seeking medical advice and/or compliance with treatment guidelines. 

If venous insufficiency is left untreated, it can lead to chronic pain, swelling, skin lesions that can develop into chronic ulcers and not infrequently thrombosis (fortunately usually superficial). Therefore, the treatment of the disease is not only about the external appearance, but mainly about maintaining the patient’s health, functionality and quality of life. 

It is worth noting that we now have studies that associate advanced Chronic Venous Disease (CVD) with cardiovascular events and increased mortality.  

What are the key diagnostic markers for differentiating CKD from other vascular diseases, such as arterial diseases?

Veins are the vessels that return blood from the legs and various organs to the heart (unlike arteries). In venous diseases, the leg is mainly heavy, swollen and “tired” and symptoms usually improve with walking. On the contrary, in arterial diseases the leg does not swell and manifests pain when walking that forces it to stop at some point. 

Varicose veinsand varicose veinsare usually obvious, but the severity of the underlying venous insufficiencymay be diagnosed only with ultrasound (triplex) of veins. Ultrasound of veins is a simple, fast, non-invasive and accurate test for diagnosing CKD. In rare cases, the doctor may recommend performing aCT scanorMRI scanof the abdomen or pelvis, usually when there is asuspected central vein occlusionthepelvisorabdomen. 

How is the appropriate therapeutic approach chosen for each stage of venous insufficiency? Is there a “window” of early intervention?

In the early stages, symptoms can be reduced and the progression of the disease slowed down with simple lifestyle changes, compression stockings and sometimes medication. Walk and exercise, this is the “window” of early “non-medical” intervention! In addition, try to elevate your legs whenever you get the chance. 

Compression stockings, when measured correctly and of good quality, facilitate venous circulation and are relieving. For the symptomatic For CKD, we also have at our disposal specialized medications (phlebotonics) and nutritional supplements that can alleviate symptoms, improving the contractility of the venous wall and venous circulation. However, no medication will eliminate varicose veins and spider veins, and it is advisable not to mislead patients by non-specialists and/or unreliable online advertisements.

In the more advanced stages (when varicose veins are evident or symptoms are severe), simple invasive techniques can provide a quick and painless solution.

What are the latest technological advances in the field of minimally invasive treatment of venous insufficiency and what is the safety profile of these methods?

TheEndoluminal(orintravenous)therapy withlaser or radiofrequencyin thetreatment of venous insufficiency, has largely replaced traditional surgery (saphenectomy) for over 10 years. No incisions or general anesthesia are required. Under ultrasound guidance, the diseased vein is identified and a thin catheter is inserted into it with a puncture that is advanced along the entire length of the vein. Local anesthesia is applied along the entire length of the vein, which will be “cauterized” by the laser or radio frequencies. The laser or radio frequencies are then activated, which heat (cauterize) the vein from the inside. The procedure takes about 20 minutes and is completed by bandaging the leg or using a graduated compression stocking for 48 continuous hours and then daily for about 2 weeks. The patient is immediately able to walk and continue his daily activities. The cauterized vein will gradually clot, harden, shrink and disappear. Blood will naturally continue to circulate through the other healthy veins of the leg.  

Modern microphlebectomy and/or sclerotherapy techniques (drug injection into incompetent veins – varicose veins) complete an optimal functional and aesthetic result.  More recently, thelaser can in selected cases be replaced by a special glue.  The safety profile of all these techniques is very high and the probability of a serious complication (e.g. thrombosis) is <1%.