Objective To determine hemodynamic changes after surgical treatment for great saphenous vein (GSV) incompetence.
Methods According to clinical, etiological, anatomical, and pathophysiological classification, all patients were classified as C2EpAsPr. A total of 976 limbs of 900 patients with primary varicose veins who underwent surgical treatment at the Samsung Medical Center were retrospectively reviewed. Surgical modalities were high ligation (HL) with stripping, endovenous laser ablation (EVLA), and radiofrequency ablation (RFA) of GSV. Hemodynamic changes were measured using air plethysmography preoperatively and 1 and 6 months postoperatively. Duplex scans were performed to evaluate the GSV status after surgery.
Results Of the 900 patients, 250, 139, and 511 underwent EVLA, RFA, and HL with stripping, respectively. All groups showed a significant increase in the ejection fraction (EF) and a decrease in the venous volume (VV), venous filling index (VFI), and residual volume fraction (RVF) at 1 month postoperatively, compared with the corresponding preoperative values. When the rate of reduction was compared between the treatment modalities, the 1-month postoperative rate of reduction in the VV was higher in the RFA group and those of the VFI, EF, and RVF were higher in the HL with stripping group, compared with the other groups (p<0.05). The GSV occlusion rates at 1 and 6 months were 85.6% and 97.5% in the EVLA group and 95.7% and 99.4% in the RFA group, respectively.
Conclusion All three surgical modalities improved the hemodynamic parameters after treatment for GSV incompetence. Thus, appropriate surgical methods can be selected according to the patient’s condition and physician’s preference.

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.

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.

Misnomers, erroneous or inappropriate designations, are a common occurrence in the medical field, often leading to confusion, misdiagnosis, and misguided treatment approaches. Within the realm of venous diseases, misnomers frequently arise in the form of inaccurate names assigned to conditions or clinical findings. The use of accurate terminology becomes essential in facilitating effective communication between venous specialists and patients. Employing precise and descriptive language improves the accuracy of diagnoses, enabling the implementation of appropriate treatment strategies and reduces cost and use of staff resources. This article aims to present prevalent misnomers in venous disease and to rectify them by employing the correct terminology, thereby enhancing patient care.

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.

Objective: Edema of the lower extremities can occur in various situations. We aim to identify the causes of edema commonly encountered in clinical practice and determine the role of vascular specialists in lower extremity edema.
Methods: From January 1, 2019, to September 30, 2019, 112 medical records were reviewed retrospectively. We referred to the algorithm for leg edema. We proposed a final diagnosis based on the medical history, physical examination, laboratory tests, imaging studies, and consultation with other specialists.
Results: Among the 112 patients, 42 (37.5%) patients were diagnosed with chronic vascular disease. Overall, 28 (25%) patients had no clearly identified causes and were considered idiopathic. Another 28 (25%) patients had musculoskeletal disorders and 10 (2.9%) patients had medical disease. There were 4 isolated cases of dermatitis, insect bites, pregnancy, and morbid obesity. 24 cases (21.4%) of the 112 patients were diagnosed with lower-extremity varicose veins, with 17 (15.2%) patients showing reflux in the saphenous vein on Doppler ultrasound.
Conclusion: In this study, various leg edema indicated the need for interdisciplinary consultations and differential diagnoses. Chronic venous disease treatment does not seem to have an absolute significance in lower extremity edema. But, vascular specialists play the role of a control tower in diagnosing lower extremity edema.

Objective: This study aimed to determine the correlation between nocturnal leg cramps and duplex ultrasound scanning (DUS) findings in patients with lower-extremity chronic venous disease with incompetent saphenous veins.
Methods: A total of 1668 limbs from 888 patients with signs and symptoms of chronic venous disease (CVD) were evaluated using DUS from April 2017 to December 2020. Limbs with saphenous vein reflux were selected for this study. Patients with a history of treatment for varicose veins, including sclerotherapy, were excluded from the study. The clinical data and DUS results were obtained retrospectively from medical records and analyzed.
Results: Nine hundred and forty limbs from 582 patients were included in this study, 66% were female patients, and the mean age was 55 (19∼86) years. There were no statistically significant differences in the distribution of sex, laterality, and CEAP clinical stage between the legs with or without nocturnal leg cramps. Age and body mass index were significantly different between legs with and without nocturnal leg cramps (p=0.02 for age and p=0.03 for BMI), but the correlations were weak (Cramer’s V=0.11 for age and 0.08 for BMI). The distribution of incompetent saphenous veins, deep vein insufficiency, and the diameter and reflux duration of incompetent saphenous veins did not correlate with nocturnal leg cramps.
Conclusion: Nocturnal leg cramps were not correlated with the distribution of valve failure in the venous system of the lower extremities.

Objective: Radiofrequency thermal ablation is an effective and safe treatment for varicose veins. Existing radiofrequency thermal ablation devices in Korea detect the temperature of the catheter to adjust the radiofrequency output. In contrast, VENISTAR^Ⓡ, a new radiofrequency thermal ablation device, detects the resistance of the vein wall during ablation to adjust the radiofrequency output. Herein, the safety and effects of VENISTAR^Ⓡ were assessed.
Methods: A total of 60 patients with varicose veins who were treated using VENISTAR^Ⓡ from January 2021 to September 2022 at our institution were retrospectively analyzed. In this study, 60 patients (41 males and 19 females) were treated with VENISTAR^Ⓡ.
Results: The mean age was 46.2±11.7 years for males and 52.7±14.2 years for females. CEAP classification was as follows: 28, 26, 4, and 2 patients had C2, C3, C4a, and C4c, respectively. A total of 89 truncal veins were treated, including 79 cases of the great saphenous vein and 10 cases of the small saphenous vein. The mean follow-up period was 190±130 days, and the success rate of treatment with VENISTAR^Ⓡ was 97.7%. Complications included 20 cases of bruising, 3 cases of phlebitis, 2 cases of recanalization, and 1 case of neovascularization.
Conclusion: VENISTAR^Ⓡ, the new radiofrequency thermal ablation device, was effective and safe for treatment of varicose veins. However, as the follow up duration of the participants was relatively short, generalization of the findings was limited. In the future, long-term studies must be conducted.

Varicose veins are a prevalent vascular disorder affecting a significant portion of the global population, leading to reduced quality of life and potential health risks if left untreated. Traditional treatments, while effective, are often invasive and associated with complications and prolonged recovery times. To provide a comprehensive review of High-Intensity Focused Ultrasound (HIFU) as a non-invasive treatment modality for varicose veins, discussing its mechanism of action, clinical applications, efficacy, advantages, limitations, and future prospects. A systematic literature review was conducted using databases such as PubMed, Scopus, and Web of Science, focusing on studies published up to October 2023 that evaluated the use of HIFU in varicose vein treatment. HIFU demonstrates high efficacy in vein closure rates, comparable to traditional endovenous therapies, with the added benefits of being completely non-invasive, minimizing patient discomfort, and reducing recovery times. Clinical studies report closure rates exceeding 95% with low complication rates. Limitations include longer treatment durations and limited availability due to high costs. HIFU emerges as a promising noninvasive alternative for the treatment of varicose veins, offering significant advantages over traditional therapies. Further advancements and broader accessibility may position HIFU as a standard treatment option in the future. Additionally, we discuss the potential application of HIFU for treating superficial venous lesions such as telangiectasia.

Non-thermal, non-tumescent (NTNT) techniques for varicose vein treatment have gained significant attention as alternatives to traditional thermal ablation methods, providing less invasive options with fewer complications and less downtime. This review examines the efficacy, safety, and patient outcomes associated with NTNT modalities such as cyanoacrylate adhesive closure, mechanochemical ablation (MOCA), and polidocanol endovenous microfoam (PEM). Recent trials suggest these NTNT methods achieve closure rates comparable to thermal methods, with lower complication rates and improved patient satisfaction. Key metrics from recent studies, including technical success, recurrence rates, and complication profiles, underscore the promise of NTNT techniques as first-line therapies. Findings also indicate variability in recurrence rates and complication profiles depending on vein anatomy and patient characteristics. In conclusion, NTNT approaches represent a promising evolution in varicose vein treatment, warranting further studies to standardize outcomes and optimize patient selection.