In diagnosing varicose veins, accurate ultrasound examinations and meticulous recording of findings are crucial, as they play a significant role in determining treatment methods. Therefore, the Korean Society of Phlebology, in collaboration with related societies, has developed guidelines for the ultrasound diagnosis of varicose veins, including standard recommendations for documenting examination records. After examining varicose veins, it is mandatory to record in writing the name of the blood vessel that was measured. For penetrating veins, it is also necessary to precisely record both the size and location. Additionally, during a provocation test involving compression, the augmented waveform and the regurgitation waveform must be documented so that they are distinctly visible in opposite directions around the baseline. Lastly, the reflux time should be specified in seconds or milliseconds.

Chronic venous disease with incompetent saphenous veins has variable treatment methods, including radiofrequency ablation (RFA) technique. RFA is a thermal treatment technique that is widely used worldwide with excellent treatment outcomes reported in many studies and currently recommended as the preferred treatment in guidelines of chronic venous diseases. Recently, in Korea, IC-RFA technique, which has different concept and principle from the existing RFA, has been developed and used in clinical practice. Unlike RFA that uniformly reproduces the ablation time and energy in incompetent saphenous veins, IC-RFA automatically controls the ablation time and energy according to the surrounding intravascular conditions. This technique has a theoretical benefit of transferring more energy for veins with larger diameters and reduced energy for small veins. Herein, we briefly introduce IC-RFA.

The pain associated with such issues with venous blood flow is expressed in various ways. Such pain in venous insufficiency is voiced as the main reason for decreased quality of life in patients. However, the exact cause of venous pain, which appears in various aspects, is unknown. Therefore, It is not easy to understanding venous pain yet. More research on this is expected to be needed in the future.

Functional chronic venous disease (FCVD; C0 category of clinical manifestation, etiology, anatomic distribution, and pathophysiology classifications) is an underestimated syndrome that affects up to 20% of the general population. FCVD is based on the presence of venous symptoms without instrumental evidence of anatomical or morphological changes. The prevalence of FCVD is underestimated owing to a lack of awareness in Western countries. Given the inflammatory nature of FCVD, we speculate that noninvasive treatments including vasoactive drugs and elastic stockings would easily relieve C0 symptoms.

Objective: Endovenous ablation can sometimes be challenged by the anatomical factors of the great saphenous vein (GSV). We aimed to evaluate the distribution of reflux and anatomical location of the GSV.
Methods: We retrospectively reviewed ultrasound images of limbs with varicose veins who underwent surgery. We evaluated the distribution of reflux and depth of the GSV, as well as the access site or ablated extent.
Results: A total of 549 limbs with GSV reflux in 450 patients were included in this study. The distal end of reflux was located in upper thigh in 9 (1.6%) limbs, mid-thigh in 41 (7.5%) limbs, lower thigh in 157 (28.6%) limbs, and below the knee segment in 290 (52.9%) limbs. The depth of the GSV was greater than 5 mm in upper thigh only in 25 (4.6%) limbs, from the junction to mid-thigh in 49 (8.9%) limbs, to lower thigh in 82 (14.9%) limbs, to the knee in 22 (4.0%) limbs, below the knee in 75 (13.7%) limbs, and in the entire length of the leg in 296 (53.9%) limbs. Lower thigh was the most frequently accessed site for the endovenous treatment.
Conclusion: Although reflux was distributed to the BK segment of the GSV in the majority of limbs, the ablation segments were often limited by the superficial location of the GSV.

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.

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.

Objective: To establish trust between patients and medical staff, and to reduce patient and guardian anxiety before surgery, we have developed and implemented the “Next of Kin Observation of Surgery Intervention” (NoKOSI). It includes a comprehensive process with sufficient explanation prior to surgery, especially attendance of family guardian during the operation.
Methods: We conducted a pilot study to evaluate the possibility of using the NoKOSI system before conducting the main study which will identify whether this system reduces anxiety and determine any clinical significance. The study included 133 patients (mean age, 52.3±13.8 and majority female gender, 88 [66.2%]) who underwent varicose vein surgery under local anesthesia between May 2022 and August 2022. The primary outcome was the actual observation rate of the participants with the NoKOSI system. The secondary outcomes were to analyze differences in modified Amsterdam Preoperative Anxiety and Information Score (mAPAIS) between the observing group (Group O) and non-observing group (Group NO).
Results: Of the 133 surgeries, 44 (33%) voluntarily participated in NoKOSI (Group O). There was no difference between the two groups in relation to age, sex, comorbidity, Chronic Venous Insufficiency, Quality of Life Scale-14 score, Venous Clinical Severity Score (VCSS), patient-reported symptom severity score (0~5), and surgical method. There was no statistical correlation between the preoperative mAPAIS score and the operative Visual Analogue Scale in all patients (r=0.013, p=ns). However, the preoperative anxiety score was significantly correlated with the Family Guardian Observation Request Scale (r=0.474, p=0.000). Of the 11 patients who reported their impression, ten gave a positive opinion and one a negative opinion. Of the 49 reported guardian responses, 38 (77.6%) were positive and 11 (22.4%) were negative.
Conclusion: In varicose vein surgeries performed under local anesthesia, 33% of family or guardians participated in NoKOSI. The necessity and efficacy of NoKOSI should be further investigated in larger prospective studies.

Popliteal vein aneurysms are a rare vascular condition that can determine severe complications as pulmonary embolism. We report 2 cases of 56 and 33-years old women, respectively, affected by a saccular popliteal vein aneurysm. Duplex scan and angiography computed tomography have been essential for a correct diagnosis and planning of both treatments. At first, the patients were subjected to anticoagulant therapy with low-molecular-weight heparin (LMWH) pending completion of the pre-operative investigations. The patients were treated surgically with tangential aneurysmectomy with lateral venorrhaphy. Follow-up at 1 and 3 months revealed normal patency of the femoro-popliteal vein axis. Neither sensory nor motor deficit were observed. Popliteal vein aneurysms are rare but have been investigated, especially in case of recurrent thrombo-embolism events. The treatment is only surgical and can be easily approached by prone positions according to the surgeon experience.

Background: This study aimed to explore the current practices and views of members of the Korean Society for Phlebology regarding incompetent small saphenous veins (SSV).
Methods: A questionnaire was sent to the Korean Society for Phlebology members via email. Of 291 members contacted, 47 responded.
Results: Preoperative duplex ultrasonography was performed by 85% of the respondents who were operating surgeons, and 92% marked the course of the SSV preoperatively using ultrasound guidance. The same treatment option was performed for all cases, regardless of anatomy or insurance coverage, by 21%. Seven members performed flush ligation at the saphenopopliteal junction (SPJ) during the surgical treatment. Four members reported positioning the terminal end of the catheter at the SPJ during the endovenous treatment. Three respondents performed endovenous thermal ablation (ETA) without tumescent instillation, and three injected tumescent solutions without ultrasound guidance. Twelve respondents performed high ligation during the ETA.
Conclusion: We verified various approaches to managing SSV among the Korean Society for Phlebology members. Evidence-based practical guidelines and education regarding the management of SSV are necessary for proper management.