[The approach to the treatment of lower-limb varicose veins]

Varicose veins have been described as early as the classical period of ancient Greece, and continue to affect the quality of life of up to one third of the population in the industrialized world. In recent years considerable progress has been achieved in understanding the pathological basis of this condition and in the development of new treatment modalities. The treatment of varicose veins of the lower limbs is primarily aimed at alleviating the symptoms, which include pain, pruritus, heaviness, ulceration, hemorrhage, and at improving unaesthetic appearance, but has also been shown to significantly improve measurable parameters of patients' quality of life and functional scales. This work reviews the current evidence on the four major treatment methods at hand: 1. Compression; 2. Stripping surgery; 3. Ultrasound guided foam sclerotherapy; 4. Thermal ablation by laser, radiofrequency or steam. Compression is a simple, low-cost treatment, but has low rates of patient compliance. The remaining invasive interventions are equally efficacious but differ considerably in their demand of skilled personnel and equipment, their adverse effects, the length of expected recovery and their economic costs. The new endovenous interventions can be performed in an ambulatory clinic under local anesthesia. They are at least as efficacious as surgery in short- and medium-term follow-up, but evidence on their long-term efficacy is still Lacking.