Chronic venous disease is a progressive condition, and long-term follow-up is essential for a comprehensive understanding. In clinical practice, conducting extended follow-ups of patients is realistically challenging, and there is still much to learn about the clinical course of varicose veins. Given the gradual progression of chronic venous disease, gaining a precise understanding is crucial for guiding patient treatment. Chronic venous disease is progressive, and early interventions such as lifestyle modifications, medication, compression stockings, or surgery help slow and prevent the progression of the disease. Our objective is to review existing long-term follow-up studies to enhance the treatment approach for patients with varicose veins.

Objective To determine whether variations in the termination of the small saphenous vein predict small saphenous vein incompetence.
Methods We conducted a prospective observational study, evaluating 133 patients diagnosed with either an isolated small saphenous vein incompetence (study group, n=47) or an isolated great saphenous vein incompetence (control group, n=86) between December 2014 and June 2015. The variations in the termination of the small saphenous vein were assessed using color Doppler ultrasound and classified according to the modified Kosinski’s classification. Data were compared between two groups.
Results Type 1 variation was more common (41/47, 87%) in patients with small saphenous vein incompetence compared to those with isolated great saphenous vein incompetence (54/86, 63%). No patients had Type 3 variation. Although not statistically significant, small saphenous vein incompetence was less common in patients with type 2 variation in the termination of small saphenous vein (16% vs. 43%; p=0.055).
Conclusion While awareness of small saphenous vein termination variations cannot predict saphenous vein incompetence, since we encounter these variations frequently, it is important to determine the type of variation before surgical treatment in order to prevent recurrence.

Venous ulcer, a condition caused by chronic venous disorder, is the most common form of leg ulcer, accounting for approximately 70% of all leg ulcer cases. The prevalence of venous ulcer is known to range between approximately 0.06% and 2%, and even when treated, it is known to recur in approximately 75% of cases. Reflux and obstruction caused by a venous disorder are both key pathophysiological factors of venous ulcer, and in particular, obstruction causes venous ulcer at a high frequency. The diagnosis of venous ulcer is based mostly on medical history, clinical presentations, and physical examination. Venous ulcers typically occur in the gaiter region and are often accompanied by telangiectasia, corona phlebectatica, atrophie blanche, and lipodermatosclerosis. Duplex ultrasonography is the most commonly used method for diagnosing chronic venous insufficiency (CVI) and assessing its causes. It can also be used to diagnose reflux and obstruction and evaluate the severity and distribution of reflux. However, although longer reflux time is typically observed in CVI, it is not always consistent with the clinical presentations. Recently, intravascular ultrasound is being adopted rapidly since it is capable of providing more accurate diagnosis and being very helpful in endovascular intervention. Treatment for venous ulcer involves reducing edema, promoting healing, and preventing recurrence of ulcer. Compression therapy is the standard therapy for CVI and venous ulcer. Elastic compression therapy is more effective than inelastic compression therapy because it offers the advantage of maintaining compression both at rest and during activities, adjusting to changes in leg size. Compressive stockings, which comprise the core component of elastic compression therapy, help to reduce residual volume fraction, an indicator of calf muscle pump improvement, and promote healing of venous ulcers by reducing reflux in venous segments. Proper wound care and dressings play a vital role in venous ulcer treatment. The wound should be kept moist at all times, while various dressings can be applied to promote healing of the ulcer. Moreover, faster healing of venous ulcer can be achieved by compression therapy with additional intravenous or surgical treatment, as compared to compression therapy alone.

Flebogrif^® is a new modality of mechanochemical ablation for incompetent saphenous vein treatment. With our experiences, it offers advantages such as reduced sclerosant dosage, shorter procedure times, lower catheter costs and in terms of closure rate as well. However, the potential for increased pain and thrombophlebitis due to more potent mechanical injury is apparent.

In the diagnosis of varicose veins, duplex ultrasound scanning is recommended as the diagnostic test of choice. Both superficial and deep veins must be tested accurately and consistently in a standardized manner. Ultrasonography, while effective, is highly dependent on the examiner and requires standardization. To ensure reliable results, it is crucial to obtain high-quality images of superficial veins using a high-frequency linear array transducer during ultrasound examinations of the lower extremities. Image optimization techniques should be employed to minimize artificial images and enhance diagnostic quality. When conducting ultrasound examinations of the lower extremities, specifically for varicose veins, performing the venous reflux test in a standing position is essential. This positioning allows for testing under conditions more similar to physiological ones, ensuring a more accurate assessment of pathological reflux influence.

Objective This study aims to evaluate the effect of treatment for great saphenous vein incompetence with a fourth-generation 1940 nm laser with radial fiber and catheter directed foam sclerotherapy (CDFS) without a tumescent simultaneously. The procedure was termed laser assisted sclerotherapy (LAST). It is a kind of thermochemical ablation.
Methods From January 1 to June 30, 2023, 86 GSV cases from 50 patients who underwent LAST at Cheongmac hospital were enrolled in this retrospective study. Endogenous laser ablation (EVLA) was performed in the order of accessary vein, tributaries and truncal vein and then followed by CDFS which was performed with a 3% sodium tetradecyl sulfate (STS) mixed with CO₂ gas at a ratio of 1:4. The degree of pain was measured after procedure at 2 hours after the procedure. Follow-up was conducted at 1 week, 1 month, and 6 months.
Results Three of the 86 GSV observed for >6 months showed mild reflux. According to size and number of ablated vessels, various energy level was needed. Three percent STS was used 4.5±0.4 cc and operation time per GSV was about 8±2 minutes. The VAS score was 2.5±0.6 at 2 hours after surgery. The closure rate was 100% at 6 months. Symptoms improved after 6 months in all patients (6.2±1.2 to 0.9±0.2).
Conclusion LAST showed a good closure rate in the early midterm follow up period. Ablation was possible with less energy compared with EVLA and the pain index was lower at the second hour after procedure.

Venous hypertension, caused by venous reflux, often leads to heaviness, swelling, and pain in the legs. However, the hemodynamics of venous flow are complex and incomprehensible, with a frequently unclear correlation between reflux and symptoms. Regarding treatment options, removal of saphenous veins (SVs) based on a few seconds of reflux can adversely affect patients. Further, indiscriminate removal of SVs in aging populations may complicate future treatment of arterial diseases. Patients should be treated selectively based on ultrasound examinations and hemodynamic principles. The CHIVA strategy, which involves treating patients without removing SVs, is a potential treatment option for patients with mild chronic venous insufficiency. In this context, we introduce the Teupitz shunt classification, which forms the basis for hemodynamic correction.

Venous flow normally circulates from the skin to superficial veins, which drain into the deep veins and the heart. Venous reflux refers to blood flow that flows in the opposite direction. Venous reflux is caused by gravity and valvular insufficiency. Diagnosing venous reflux is important to determine treatment for lower extremity venous disease. Unlike arteries, venous reflux is greatly affected by the relative position of the probe and the vessel. Standardized ultrasound images are required to verify venous reflux using ultrasound. It is important to perform the reflux provocation test using the standardized posture and method.

Left-sided inferior vena cava (IVC) is a congenital venous anomaly variant with an incidence of 0.2%–0.5%. Furthermore case of abdominal aortic aneurysm with left-sided IVC is very rare. We reported our experience with two cases of left-sided IVC during open repair of the abdominal aortic aneurysm.

Chronic venous ulcers are a debilitating condition that often significantly impacts the quality of life due to their tendency to recur. Recently, we encountered a case of challenging chronic obstructive iliofemoral venous disease, presenting as postthrombotic syndrome with a venous ulcer. Venous duplex ultrasound revealed evidence of venous reflux in the left great saphenous vein and small saphenous vein. A CT venogram indicated occlusion in the proximal femoral vein, common femoral vein, and external iliac veins, with collateral veins in the lower abdomen. This lesion was treated using a combination of two types of venous stents. A one-month follow-up revealed improvement in the patient’s edema and ulcer.