Study material for the course: aVLCH0731c, aVLCH0832c, aZLCH0732c, aZLCH0833c
Author: MUDr. Luboš Kubíček, Ph.D.
Department: 2nd Department of Surgery, St. Anne's University Hospital, Faculty of Medicine, Masaryk University in Brno
Main goal of
this lecture is to present the topic of varicose veins of lower limbs. Varicose
veins are common disease with rich symptomatology based on a stage of the
disease from small venectasia to vast venous ulcers severely limiting patients
quality of life. Other goal of this lecture is to learn the types of varicose
veins and risk factors which can lead to their development. The same importance
is to learn basic diagnostic process which can lead us to right treatment
decisions tailored for each patient. As there are many symptoms of this disease
so there are many treatment options as well, ranging from conservative
treatment to classic surgery and further to modern endovenous methods, last
goal of this lecture is to present the principle of each method, with their
advantages and disadvantages.
Varicose veins
are very common disease affecting patients both in young and older age, its
prevalence gets higher with higher age. Clinical image of the disease is
various based on the stage of damage to the superficial veins, ranging from
venectasia to vast non-heling venous ulcers, which can limit patients quality
of life significantly and can ale cause severe pain. Varicose vein treatment is
a classical procedure even from the antique times. The golden standard of
surgical treatment is phlebectomy and stripping of great saphenous vein (GSV).
In the last decades there is also a boom of mini-invasive methods, so called
endovenous methods, including laser and radiofrequency ablations. These methods
can be performed in ambulance under local anesthesia and patient is recovered
faster than after surgery. Their main disadvantage is the price of the
procedure which is not covered by insurance and this price can be too high for
a considerable portion of the patients.
Time required
for this lecture: 60 minutes
The most
important information from this lecture is that varicose veins are common
disease which can in higher stages cause significant problems to the patient.
There are many treatment options ranging from conservative therapy with compression,
exercise and venotonics medication over mini-invasive methods such as
sclerotherapy and phlebectomy and endovenous methods to classic stripping of
vein trunks. From the beginning of 21st century we can see a shift from classic
surgical methods to endovenous methods, however the classic stripping is still
the golden standard in varicose vein treatment. Since we now have a many
treatment options the therapeutic decision should be made to fit a particular
patient considering his/her preferences and resources.
After this
lecture student should be able to recognize varicose veins from the lowest
stage of venectasia to venous ulcers. Student should be able to recognize basic
symptoms of the disease what are mostly venectasia and dilated superficial
veins what in combination with patient medical history and physical examination
should give us the right diagnose. This must be confirmed by ultrasound
examination what is the part for experienced sonographer. Student should know
treatment options for this disease and should be able to say which one is the
best for particular patient based on the clinical status and patient
preference. Student should be able to answer patient questions regarding the
treatment options and should propose the best solution.