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.

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.

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.

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.

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.

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.

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.

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.

Lymphedema is a chronic progressive condition caused by insufficient lymphatic drainage and subsequent stasis of protein-rich interstitial fluid. When it occurs, the lymphatic fluid becomes stagnant, causing tissue fibrosis, hypertrophic fat, and lymphatic vessel destruction, ultimately leading to skin ulceration and infection. Lymphedema can be a debilitating disease in patients and has a dramatic negative effect on their quality of life. Invasive reductive procedures such as the Charles operation were previously performed, but this resulted in extensive scarring and substantial morbidity, including significant blood loss or infection. Therefore, in recent years, physiologic surgeries such as lymphaticovenular anastomosis and vascularized lymph node transfer have become increasingly popular. This article reviews recent trends in the surgical management of lymphedema from physiologic surgery to preventive lymphatic reconstruction.

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.