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Study material for the course: aVLCH0731c,  aVLCH0832c, aZLCH0732c, aZLCH0833c

Author: MUDr. Luboš Kubíček, Ph.D.

Department:   2^nd 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.