Evolution of surgical treatment methods for patients with varicose veins

INTRODUCTION: Treatment of varicose veins (VV) and their complications has history of several centuries. Throughout the 20th century, the surgery of choice was phlebectomy in different modifications. In recent decades, minimally invasive techniques have become the priority, which has been facilitated by technological advances and the advent of high-precision equipment minimizing surgical trauma. AIM: To conduct a comparative analysis of existing surgical treatment methods for varicose veins of the lower extremities based on literature data in terms of recurrence rates, complications, morbidity, and cost-effectiveness. An analysis of Russian and foreign publications (n=163) devoted to the surgical treatment of VV has been conducted. The search was conducted in the eLibrary and PubMed databases of biomedical publications for the past 8 years using the following keywords: varicose veins of the lower extremities, varicose vein surgery, phlebectomy, laser vein removal, endovenous laser obliteration, radiofrequency ablation, miniphlebectomy, endovenous laser ablation, mechanochemical endovenous ablation, surgery for treatment, cyanoacrylate embolization, radiofrequency ablation. From the results of the primary search, 86 articles were excluded as non-corresponding to the aim of the study. In addition, 17 articles from the period 2004–2017 were used to highlight less-used but still relevant methods. The analysis showed that the number of open interventions on the venous system has significantly decreased in recent years. Modern innovative treatment methods for patients with VV to a more extent take into account the pathogenesis of their development and physiology of venous outflow. Innovative technologies have been demonstrated to improve the quality of patients’ life both in the early and late postoperative periods, and also to reduce the incidence and severity of complications. Various novel, minimally invasive surgical treatment methods for VV are being introduced in the clinical practice of hospitals, outpatient clinics and are included in the clinical guidelines. An individual approach is important in choosing the optimal variant from the wide range of modern surgical treatments for VV. CONCLUSION: Minimally invasive treatment methods for VV are comparable in effectiveness with open phlebectomy, but have fewer complications. They are less traumatic, but more cost-effective, and thus can be referred to hospital-substituting technologies with transfer of surgical treatment for VV to an outpatient setting.