Historic milestones in the management of lower limb varicose veins

Abstract

Lower limb varices have been known and described for more than 3500 years. Through the ages, numerous modalities have been used in the management of this condition. Many of these methods evolved and, after some modifications, remain in use. Surgical techniques of major importance in the management of varices of the greater saphenous vein include crosscutting of the venous ostium (crossectomy) and partial or complete removal of the venous trunk (stripping). Conservative management consists of drug therapy and compression therapy. Another major achievement was the development of sclerotherapy using injections of chemical substances, which was introduced after the invention of the syringe. Surgical procedures involving the greater saphenous vein are still associated with a high recurrence rate. Currently available methods of vein obliteration, such as radiofrequency ablation, laser therapy, and foam sclerotherapy, are expected to improve long-term outcomes, reduce local tissue trauma, and result in an improved cosmetic effect. Discussions regarding the optimal approach to the management of lower limb varicose veins should also include knowledge about the historical aspects of the treatment of this condition, especially with the centennial anniversary of the introduction of the Babcock procedure that remains in common use.