Varicose veins are the most common disease of the veins and have been known for centuries. Hippocrates himself (469-375 BC) described in his work “On Ulcers” the destruction of a varicose vein with a rod. Today, one in three women and one in five men suffer from varicose veins, i.e., visible, dilated veins or spider veins.
In most people, the disease remains asymptomatic, but it often manifests with symptoms such as a feeling of "heaviness" in the legs, swelling, pain, hyperpigmentation of the skin, and in a few cases, if left untreated, it can progress to the appearance of wounds and ulcers that are difficult to heal.
Surgical Treatment
The surgical treatment of varicose veins has experienced many evolutionary processes in the last century, and specifically since 1907, when Babcock first described the classic open surgical method of excision of the deficient portion of the saphenous vein. This, along with its obvious evolutionary mutations, was the reference point in the treatment of varicose veins for about a century.
Laser Treatment
new bloodless intraluminal methods have appeared , which we colloquially identify – unilaterally, but not incorrectly – with the term “Laser”, and which, with their results, have offered a very valuable alternative to classic open surgical treatment.
These do not remove the “diseased” vein, but rather cauterize its lumen, thus stopping the backflow that is responsible for the onset of the disease. For the record, I should mention that in addition to Laser, the bloodless cauterization methods of the last twenty years also include Radiofrequency, which is technically very similar and bibliographically just as effective.
Bloodless methods have dominated the daily routine of varicose vein treatment so much that one wonders "does the classic open surgical method still have a reason to exist?"
Comparison of the two methods
The classical method, when there is a surgical indication, is always applicable and a medically correct choice. However, the large surgical trauma compared to the microincisions (up to 5 millimeters) of modern methods – although it does not affect the recovery to a statistically significant degree – brings about complications related to it and amount to around 3 – 10% (slight pain, infection, secondary healing, etc.). In addition, superficial nerve damage, usually of a minor degree (7 – 39%), as well as deep vein thrombosis (0.5 – 5%) have been reported.
On the contrary, “bloodless” methods are not always applicable. Their main limitations are the distance of the vein from the skin, which according to guidelines should not be less than 1 cm, the diameter of the vein, which should not exceed 1.5 cm, its course under the skin, which should not present significant tortuosity, and that there should be no previous significant thrombophlebitis. When none of the above limitations are present, complications are minimal.
Indicatively, I mention deep vein thrombosis (<0.5%), skin burns (<0.5%), paresthesias (3%), skin hyperpigmentation (2%), transient ecchymoses (6%) and thrombophlebitis (1%).
Recurrence of the disease
Both methods share – for different reasons – the same rate of relapse (i.e., recurrence of the disease), which amounts to approximately 15%.
Conclusion
Therefore, due to the anatomical and morphological limitations of the new bloodless methods, we can summarize that the classic open method has not been sidelined, it simply specializes its field where the field of indication of the new methods stops.
Of course, these are not competing methods but complementary, which can also be combined in a patient's treatment strategy. In the hands of an experienced vascular surgeon who has all the methods in his repertoire, the appropriate treatment can be adapted to the patient's needs.
