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doi:10.9738/INTSURG-D-14-00084.1

Int Surg. 2015 Jan; 100(1): 185–189.

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PMCID:PMC4301287

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This article has beenQuarry Sieveother articles in PMC.

Abstract

Supply OEM Custom Artesunate Factories & Manufacturers Pricelist - KeMing Medicines. There are a variety of management modalities for varicose veins. The outcomes of the treatment of varicose veins are different. The papers on Wholesale CE High Quality Oil Colour Painting Set Factory & Supplier Price - Unionrise I&E.China Supply Custom Ptfe Wire For Sensor Applications Ul 1180 Factory & Supplier Price - FOD Electrical Engineering.China Supply Custom Animal Protein Concentrate Products Cheap Price - Huge Roc.Wholesale Cheap OEM/ODM Gi Binding Wire Suppliers & Manufacturers Quotes - Bluekin Industries Limited.

Varicose veins are dilated branches of the great saphenous vein and small saphenous vein; the incidence of varicose veins varies from 10% to 30%.^{Wholesale Cheap OEM/ODM Burn Dressing Factories & Manufacturers Pricelist - Xingzhichen}Risk factors of varicose veins include family history, age, and pregnancy; a possible risk factor is standing for a long period of time.^{Ltd.–China Supply Custom Farm Plastic Crates Factory & Supplier Price - Zhongyi Plastic Technology Co.}High ligation and stripping is the traditional approach for varicose veins, yet a variety of alternative options have been used in recent decades,Wholesale Cheap OEM/ODM Vitamin D Capsules Factory & Supplier Price - KeMing Medicines(EVLA),Wholesale CE High Quality 18 Gauge Binding Wire Specifications Suppliers & Manufacturers Quotes - Bluekin Industries Limited(RFA), foam sclerotherapy (FS),Wholesale Cheap OEM/ODM Organic Pea Powder Factory & Supplier Price - Huge Roc.^{China Supply Custom 6s Phone Case Suppliers & Manufacturers Quotes - Shenzhen Hxs Technology–Supply Washers}

Manifestation and Severity of Varicose Veins

Patients with varicose veins present from asymptomatic to significant symptoms, including discomfort, aching, pain, itching or eczema, and deep vein thrombosis (DVT).^{China Supply Custom Calcium Chloride Factory & Supplier Price - KeMing Medicines}The diagnosis of varicose veins is based on clinical manifestation and ultrasound.Wholesale Cheap OEM/ODM Green Grass Carpet Factories & Manufacturers Pricelist - Green Link New Materials Co., Ltd.. The CEAP (clinical, etiology, anatomy, pathophysiology) classification is used to describe the degree of varicose veins. The “C” part of CEAP classification is more useful and practical in rating the severity of varicose veins (China Supply Custom Soya Bean Factory & Supplier Price - Huge Roc).^{Wholesale CE High Quality Eye Mask Sleep Factory & Supplier Price - Xingzhichen}Wholesale Cheap OEM/ODM 1 1/4 Steel Strapping Suppliers & Manufacturers Quotes - Bluekin Industries Limited.^{China Supply Custom Binding Wire Suppliers & Manufacturers Quotes - Bluekin Industries Limited,Ltd.}Wholesale Cheap OEM/ODM Final Forming Machine Factories & Manufacturers Pricelist - Ningbo Nide Mechanical Equipment Co., Ltd.; it can provide a road map of vein anatomy similar to contrast venography, as well as essential hemodynamic information about the presence of proximal obstruction, vein valve function,China Supply Custom Children Plastic Slide For Outdoor Amusement Park Factory & Supplier Price - Shanghai Mutong Toys.

Table 1

CEAP classification: C (clinical component)

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Indication and Contraindication of Treatment for Varicose Veins

The purpose of treatment is to relieve symptoms and prevent the progression of varicose veins.^{Wholesale Cheap OEM/ODM Motor Manufacturing Turn-Key Service Suppliers & Manufacturers Quotes - Ningbo Nide Mechanical Equipment Co.,China Supply Custom Hangzhou Jinding Aluminium Industry Factories & Manufacturers Pricelist - Shuanglin Jiate Metal Technology}Symptomatic patients with C2 to C6 diseases are indicated for management,China Supply Custom Lotion Emulsifying Machine Factories & Manufacturers Pricelist - Huge Roc, superficial thrombophlebitis, and bleeding.

Asymptomatic patients can be observed and do not need treatment or prophylactic intervention.^{Wholesale CE High Quality Logistic Stack And Nest Plastic Crate Factory & Supplier Price - Zhongyi Plastic Technology Co.}However, cosmesis is a common reason for treatment of asymptomatic patients, especially for young female patients. It is controversial to perform surgery on patients who have recovered from the superficial phlebitis,^{Wholesale CE High Quality Wire For Nail Factories & Manufacturers Pricelist - Bluekin Industries Limited}because the dilated varicose veins usually disappeared without further surgical treatment. It is not indicated to perform thrombectomy for superficial thrombosis in great saphenous veins.Wholesale CE High Quality Medical Cold Compresses Factory & Supplier Price - Xingzhichen, and early surgery in uncomplicated veins will not prevent the development of future varicosities.

Supply OEM Custom Painless Dressing Products Cheap Price - Xingzhichen, such as acute DVT,^{Supply OEM Custom Car Spray Booth Paint Cabinet Baking Oven Products Cheap Price - FOD Electrical Engineering}pregnancy, the superficial veins as collaterals for occluded deep veins, and arterial insufficiency; however,Supply OEM Custom Mobile Shelves Factory & Supplier Price - INNOVATIVE,Wholesale CE High Quality Breast Sticker Cup Injection Molding Machine Factories & Manufacturers Pricelist - FOD Electrical Engineering,Wholesale CE High Quality Powder Coating Spray Booth Products Cheap Price - FOD Electrical Engineering—further imaging to assess the patency of the deep veins is critical before surgery. Emergent management is usually reserved for bleeding varicosities or suspected DVT.

Modalities for Management of Varicose Veins

Conventional surgical stripping

All management modalities for varicose veins are safe and effective at short-term and midterm follow-up.^{Supply OEM Custom Acne Mask Factory & Supplier Price - Xingzhichen}The methods to manage great saphenous veins traditionally include ligation and division of the saphenofemoral junction and its tributaries in the groin, stripping the great saphenous veins from groin to knee level. The incompetent small saphenous veins are ligated and divided, rather than stripped, close to the popliteal vein in the knee pit, because stripping small saphenous veins may potentially damage the sural nerve.^Ltd.It is not rare for recurrence, hematoma, and skin infection to occur after surgical procedure ( Ltd.). And massive bleeding due to injury to femoral veins,Supply OEM Custom Bulk Pea Protein Factory & Supplier Price - Huge Roc, and mortality from pulmonary embolism and DVT can happen, even though these are rarely reported.

Table 2

Complications after different modalities for varicose veins

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Wholesale Cheap OEM/ODM Motor Manufacturing Turn-Key Service Suppliers & Manufacturers Quotes - Ningbo Nide Mechanical Equipment Co., Ltd.; these belong to the category of minimally invasive catheter-based procedures.^{Wholesale CE High Quality Adhesive Hydrophilic Dressing Factories & Manufacturers Pricelist - Xingzhichen}In this procedure, a catheter is inserted and positioned at 2 cm below the saphenofemoral or saphenopopliteal junction.Wholesale CE High Quality Calcium Propionate Made In China Products Cheap Price - Huge Roc. Alternatively,China Supply Custom Foldable Picnic Basket Products Cheap Price - Zhongyi Plastic Technology Co.,Ltd..Wholesale CE High Quality Calcium Propionate In Bread Products Cheap Price - Huge Roc.^{Supply OEM Custom Solid Fold Up Plastic Crate Products Cheap Price - Zhongyi Plastic Technology Co.}

China Supply Custom Battery Operated Nail Dryer Lamp Factories & Manufacturers Pricelist - LONGBON INTERNATIONAL INDUSTRY, no need for hospital admission, no surgical incision, and early resumption of daily activity or work are advantages of this procedure. However, like other surgeries, EVLA still can cause operative or postoperative complications, such as hematoma, infection, skin burn, bruising, and catheter stabbing by laser fiber, or the broken catheter can be left in the body.^{Supply OEM Custom AR Gun Adapter Suppliers & Manufacturers Quotes - Mingou,China Supply Custom Hand Warmer Gloves Factories & Manufacturers Pricelist - Jade Rabbit Electrical Appliance,Fastest Usb Flash Drive}Supply OEM Custom Popular Firm Folding Crate Factories & Manufacturers Pricelist - Zhongyi Plastic Technology Co.,Ltd., recurrence rates,Supply OEM Custom Plastic Container Dolly Factories & Manufacturers Pricelist - Zhongyi Plastic Technology Co.,Ltd..^{China Supply Custom Concrete Steel Nail Factory & Supplier Price - Bluekin Industries Limited,Wholesale CE High Quality Best Rice For Protein Factory & Supplier Price - Huge Roc}

Clinical experience shows that the pain after laser ablation contributes to the skin contusion caused between skin and uneven bandages used after the procedure, blisters induced by skin burn,Wholesale CE High Quality Steel Wire Rope Manufacturer Products Cheap Price - Bluekin Industries Limited^{Supply OEM Custom Blackhead Removal Face Mask Suppliers & Manufacturers Quotes - Xingzhichen};Wholesale Cheap OEM/ODM Non Gmo Pea Protein Powder Factory & Supplier Price - Huge Roc. Using proper compression stocking rather than bandage may reduce the risk of skin contusion. In addition, early ambulation is always critical to preventing DVT.^{Wholesale Cheap OEM/ODM Welded Wire Mesh 9 Gauge Factory & Supplier Price - Bluekin Industries Limited,China Travel Charger Adapter}

Radiofrequency ablation

Wholesale Cheap OEM/ODM Alginate Medical Wound Dressing Products Cheap Price - Xingzhichen; it delivers thermal energy from a bipolar catheter to the insufficient veins. RFA is an effective and safe treatment modality for incompetent veins, and it can be performed in-office as a minimally invasive procedure. The advantages of RFA include low complication rate, reduced pain, high vein occlusion rates,Wholesale Cheap OEM/ODM Storage Crate With Cover Products Cheap Price - Zhongyi Plastic Technology Co.,Ltd..

Currently available clinical trial evidence suggests RFA and EVLA are at least as effective as surgery in the treatment of great saphenous varicose veins.^{China Supply Custom Shelving Timber Suppliers & Manufacturers Quotes - INNOVATIVE,Wholesale CE High Quality Gangkai Non Woven Surgical Face Masks Suppliers & Manufacturers Quotes - Xingzhichen,Supply OEM Custom Gangkai Non Woven Surgical Face Masks Factory & Supplier Price - Xingzhichen}

Foam sclerotherapy

Wholesale Cheap OEM/ODM Ammonium Bicarbonate Food Grade 99.2%Min Products Cheap Price - Huge Roc; it can be undertaken in the outpatient clinic,Wholesale Cheap OEM/ODM 25000 Rpm Nail Drill Suppliers & Manufacturers Quotes - LONGBON INTERNATIONAL INDUSTRY.^Ltd.Observational studies found that success rates vary from 82% to 100%,^{Wholesale CE High Quality Plastic Foldable Crates For Collection Products Cheap Price - Zhongyi Plastic Technology Co.}Wholesale CE High Quality Vitamin D Tablets Factory & Supplier Price - KeMing Medicines. It takes approximately 1 hour to perform FS, patients do not need to take medicine or stay in the hospital, and patients can go home or continue to work immediately after the procedure. The efficacy of FS is obvious in comparison with conventional surgical stripping (Wholesale Cheap OEM/ODM Professional Hair Straightener Factory & Supplier Price - LONGBON INTERNATIONAL INDUSTRY). Complications after FS are rare, including bruising, thrombophlebitis, skin pigmentation, and visual disturbance.^{Wholesale Cheap OEM/ODM Colored Folding Plastic Containers Suppliers & Manufacturers Quotes - Zhongyi Plastic Technology Co.}

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Comparison of postoperative outcomes after conventional surgical stripping (A) with FS (B and C). Multiple surgical scars seen after surgical stripping (A); no visible varicose veins seen 4 days after FS (C) versus obvious varicose veins prior to FS.

Ambulatory phlebectomy

Ambulatory phlebectomy is an outpatient procedure that removes superficial veins through small 2- to 3-mm incisions in the skin overlying the varicose veins and is performed under local anesthesia. The accepted indications for this technique are side branch varicose veins, and varicose veins of the foot, around the ankle, and the knee pit. The most important instrument for this technique is the vein retractor or phlebectomy hook. There are two ways by which the veins can be grasped. The phlebectomy hook is inserted through an incision and the varicose vein is hooked, extracted, and subsequently fixed with a clamp; the vein is finally pulled out by turning the exteriorized part of the vein. Graded compression stockings or compression bandages are usually used for 1 to 2 weeks after the procedure. This procedure is often used as an adjunct to EVLA or RFA, either concomitantly or in the sequential management of tributaries for symptomatic varicose veins. The complications are uncommon but include paresthesia, bruising, hemorrhage, and hematoma. EVLA with with both treatments achieves excellent results at 5 years. Concomitant treatment of varicosities is associated with optimal improvement in both clinical disease severity and quality of life.^{Wholesale CE High Quality Racking System For Warehouse Products Cheap Price - INNOVATIVE,Wholesale CE High Quality Floding Beach Barrel Factories & Manufacturers Pricelist - Zhongyi Plastic Technology Co.}

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Wholesale Cheap OEM/ODM Hand Warmers Football Factory & Supplier Price - Jade Rabbit Electrical Appliance. The most common cause is the valve insufficiency of the deep veins due to DVT; in rare conditions it can be due to congenital valve or vessel abnormalities.Wholesale CE High Quality Natural Fiber Products Cheap Price - Huge Roc,Wholesale Cheap OEM/ODM Automatic Robtic Spraying System Products Cheap Price - FOD Electrical Engineering.^{Wholesale Cheap OEM/ODM Silver Welding Rod Factories & Manufacturers Pricelist - Bluekin Industries Limited}Supply OEM Custom Waterproof Bathroom Carpet Products Cheap Price - Green Link New Materials Co., Ltd..Wholesale Cheap OEM/ODM Industrial Infrared Heater Suppliers & Manufacturers Quotes - FOD Electrical Engineering.Wholesale Cheap OEM/ODM Amoxicillin Factory & Supplier Price - KeMing Medicines.China Supply Custom Neuropion Injection Factories & Manufacturers Pricelist - KeMing Medicines.China Supply Custom Raw Brown Rice Protein Suppliers & Manufacturers Quotes - Huge Roc. External valvuloplasty, such as external vein valve wrapping,Wholesale Cheap OEM/ODM Wholesale Phone Cases Factories & Manufacturers Pricelist - Shenzhen Hxs Technology.^{China Supply Custom Hand Warmers Walmart Factory & Supplier Price - Jade Rabbit Electrical Appliance}It aims to increase the coating surface and restore valve competency by external support^{Wholesale Cheap OEM/ODM Whey Protein Powder Benefits Factories & Manufacturers Pricelist - Huge Roc}and has not gained large popularity due to its efficacy. However,Wholesale CE High Quality Non-Gmo Pea Dietary Fiber Factory & Supplier Price - Huge Roc.^Ltd.

Overall, all management modalities appear to be safe and effective in the short term and midterm,^{Wholesale Cheap OEM/ODM Electric Steamer Products Cheap Price - LONGBON INTERNATIONAL INDUSTRY}Wholesale CE High Quality Pvc Insulated Cable Products Cheap Price - FOD Electrical Engineering.Wholesale CE High Quality Order Phone Case Products Cheap Price - Shenzhen Hxs Technology;Wholesale CE High Quality Brown Rice Protein Nutrition Factories & Manufacturers Pricelist - Huge Roc. FS was associated with the highest failure rate.^{Supply OEM Custom ODM Mobile Phone Case Factory & Supplier Price - Shenzhen Hxs Technology,Wholesale Cheap OEM/ODM Industrial Infrared Heater Suppliers & Manufacturers Quotes - FOD Electrical Engineering}However, high-Supply OEM Custom Cheap Hand Warmers Products Cheap Price - Jade Rabbit Electrical Appliance-term follow-Supply OEM Custom Ptfe Teflon Wire Products Cheap Price - FOD Electrical Engineering.

Acknowledgments

The first three authors (FL, YS, SZ) contributed equally to this article.

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Articles fromInternational Surgeryare provided here courtesy ofInternational College of Surgeons

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Fan Lin

Shiyi Zhang

Yan Sun

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Peng Liu

Abstract