Varicose veins are one of the most common vascular problems seen in out patient clinic. They affect about 15% of the adult population. Most varicose veins are the result of a congenital or familial predisposition that lead to loss of elasticity in the vein wall and the absence or incompetence of venous valves. These primary varicosities generally progress downward in the greater saphenous system. Secondary or acquired varicosities occur when the venous valves have been damaged by trauma, deep vein thrombosis, or inflammation. The basic pathophysiology of varicose veins are summarized and the initial lower extremity venous examination is described. The author focuses on the diagnosis and treatment of varicose veins in the legs including new treatment trends. (J Korean Soc Phlebol 2002;1:3-8)

Tortuosity and dilatation of veins is a typical sign of varicose veins. Mechanism of tortuosity development and vein dilatation is the major pathogenesis of varicose vein and therefore it is closely related to the risk factors for varicose vein. The greatest known risk factor for varicose vein is body posture to increase hydrostatic pressure. Recent research shows that an increase in venous hydrostatic pressure is sufficient to promote venous remodeling by increasing wall stress and activating venous endothelial and smooth muscle cells. Mechanical forces can alter molecular environment and the activator protein 1 (AP-1) is suggested a prerequisite for venous remodeling. So-called biomechanical mechanism is one of the basic concepts that describe abnormal tortuosity and dilatation of veins. But the most fundamental and significant method for prevention and treatment of varicose vein is still to reduce the venous filling pressure despite the fact that many molecular mechanisms can provide the explanation for the causes of varicose vein. (Korean J Phlebology 2015;14:8-10)

Background: Prolonged standing or sitting at work is associated with a high prevalence of chronic venous disease (CVD). We aimed to evaluate the prevalence of CVD by assessing its occurrence and symptoms in hospital health care workers.
Methods: We retrospectively analyzed healthcare workers from one university hospital who agreed to take a questionnaire on lower extremity symptoms. The VEINES-QOL/Sym questionnaire was used for clinical evaluation.
Results: A total of 1,166 healthcare workers participated in the survey; 247 (21.2%) were male and 919 (78.8%) were female. The mean age of the participants was 36.3±10.8 (19∼67) years. Of the total participants, 237 (20.3%) had no disease, 552 (47.3%) had mild disease, and 377 (32.3%) had moderate to severe disease. The mean (SD) VEINES-QOL/Sym score (score) for all participants was 67.29 (12.38). When sorted by sex, the total scores were significantly lower for female participants than for their male counterparts (female, 64.6±11.5 vs. male, 77.3±10.4, p＜0.001). The total scores of the nurses/nurse assistants of both sexes were 63.1±11.5. The active group score was 77.6±9.8, the mid-group score was 70.7±11.3, and the sedentary group score was 76.3±9.4 (p＜ 0.001). Linear regression analysis revealed that female sex, age, total working years, and work-related mobility were significantly related to the total score (all, p＜.001).
Conclusion: The prevalence of clinical CVD and venous reflux was high among health care workers. Female sex, nursing vocation, and prolonged standing at work were risk factors for CVD. Prevention and proper management of CVD to improve quality of life should be considered, especially in those groups with high risk factors.

COVID-19, a pandemic currently, is known to cause hypercoagulability, but may cause deep vein thrombosis (DVT). Generally, D-dimer is useful for diagnosing DVT, but in COVID-19 patients, there is a high possibility of false positives due to the accompanying infection. A literature review revealed that D-dimer levels are elevated in patients with COVID-19. Therefore, a new D-dimer cutoff value for DVT in COVID-19 is needed. Higher D-dimer levels in COVID-19 patients are significantly associated with disease progression.

The following are included in the 2020 update of the CEAP classification: addition of the modifier “r” to the C2 and C6 recurrent disease, addition of corona phlebectatica to the C4 class as a separate subclass (C4c,) subcategorization of ES (secondary etiology) into ESi (intravenous secondary etiology) and Ese (extravenous secondary etiology), and the use of anatomic abbreviations instead of numbering the venous segments in the anatomical classification. Researchers should understand the definition of the recurrence of varicose veins and the diagnostic criteria of corona phlebectatica.

Objective: Current guidelines recommend that prophylactic antibiotics should not be used in endovenous surgery. However, it remains unclear whether prophylactic antibiotics are necessary for the combined endovenous procedure with concomitant phlebectomy.
Methods: We conducted a propensity score-matched case-control study to assess post-procedural infection rates based on the use or non-use of prophylactic antibiotics. Initially, the study included 587 patients (mean age of 55.8 ±14.2 and 296 (50.4%) women) undergoing combined endovenous surgery with concomitant phlebectomy from 2018 to 2022. All procedures were performed under local anesthesia without any sedation. The primary outcome was to compare the incidence of surgical site wound infection (SSWI) after the combined procedure between the prophylactic antibiotic use (PA group) and non-use group (nPA group). The secondary outcomes were to analyze requirement of antibiotics due to any cause three months postoperatively and determine the incidence of thrombophlebitis requiring antibiotic treatment. After propensity score matching, 201 patients who received prophylactic antibiotics (PA group) and 201 who did not (nPA group) were selected, and the present study analyzed 402 participants.
Results: The mean number of concomitant phlebectomies was 3.54±2.3 in the nPA group and 3.68±2.40 in the PA group (p=ns). The type of endovenous treatment (p=0.79 for VenaSeal, p=0.42 for radiofrequency ablation, p=0.52 for endovenous laser ablation, and p=0.38 for ultrasonographic foam sclerotherapy) and number of phlebectomies (3.61±2.3 in no SSWI group vs. 4.40±5.0 in SSWI group) were not associated with postoperative SSWI incidence. In the logistic regression test, the preoperative great saphenous vein size was a unique risk factor for postoperative SSWI (odds ratio 1.442, 95% confidence interval 1.12∼1.80, p=0.004).
Conclusion: Both nPA and PA strategies had a very low and comparable incidence of SSWI after combined endovenous surgery and concomitant phlebectomy for chronic venous disease treatment. The nPA strategy did not increase post-procedural SSWI. An optimized and individualized protocol for the use of antibiotics is needed.

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.

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.

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.

Treatment decision of varicose veins should be made based on the patient’s symptoms, but it is important to confirm the presence of reflux when selecting a treatment method. The definition of reflux, which is the core of ultrasound diagnosis of varicose veins, is recommended as follows. In the case of the great saphenous vein, anterior and posterior accessory saphenous vein, small saphenous vein, perforating vein, tibial vein, and deep femoral vein, reverse flow of more than 0.5 seconds is considered as reflux. In the case of the common femoral vein, femoral vein, and popliteal vein, reverse flow of more than 1.0 seconds is considered as reflux. In cases of reticular veins, spider veins, and telangiectasia, because the clinical significance of measuring reflux through ultrasound has not yet been proven and they are often observed regardless of saphenous vein reflux, ultrasound diagnostic criteria are not provided.