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.

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.

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.

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.

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: 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: 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.

An 82-year-old female was referred from a local clinic due to left leg swelling despite 1 month of direct oral anticoagulant therapy for left iliac deep vein thrombosis. Enhanced computed tomography (CT) revealed a hypoplastic iliac vein with several iliac and popliteal arteriovenous fistulas (AVFs), without significant iliofemoral deep vein thrombosis. First, endovascular balloon angioplasty was performed for iliac vein hypoplasia related to a previous deep vein thrombosis. On postoperative day 4, CT angiography was performed due to persistent left leg edema with circumference discrepancy, which confirmed narrowing of the left common iliac vein with extrinsic compression between the right common iliac artery and vertebral body. Persistent left leg edema required an additional endovascular procedure; more specifically, placement of an iliac vein stent. After restoration of circumference equality in both the thigh and calf, the patient was discharged from hospital on antiplatelet and antithrombotic medications. Three months later, the patient visited again due to recurrent left leg edema, with a circumference discrepancy measuring ＞10 cm. Iliac vein balloon angioplasty was performed, as was additional stent placement for May-Thurner syndrome (MTS) and coil embolization of the iliac AVF. Endovascular embolization resulted in full recovery from MTS with coexisting iliac AVFs. MTS combined with ilio-iliac AVF(s) may be a neglected phenomenon, although it is not very rare. The present report reviews this disease category and raises awareness of possible disease mechanisms(s).

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: 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.