[Diagnosis and surgical management of varicosities]

The diagnosis of varicose veins is based on historical details pertaining to risk factors such as familial preponderance, advanced age, overweight, multiple births, professional activities carried out mainly in the standing or sitting position, use of oral contraceptives, diuretics or drugs which lower venous tone. Swelling of the legs on prolonged recumbancy, during pregnancy, fractures or cast treatment may be associated with thrombosis (Table 1). In addition to inspection and palpation in the standing and lying positions, the status of the pulses and the joints are of importance. The diagnostic measures must clarify the stage of the chronic venous insufficiency and provide adequate information on the various forms of venous functional disturbances (Table 2). Classification of varicose veins is carried out according to etiology--primary or secondary--or according to anatomical and functional derangement: with varicosities of the great saphenous vein and the lesser saphenous vein, in addition to valve incompetence at the proximal confluence of the saphenous-femoral junction, there may be segmental or global valve incompetence frequently in combination with a perforating vein incompetence. Varicosities of the great saphenous vein are classified with respect to whether the venous valves involved are those only in the region of the proximal confluence or from the inguinal region to above or below the knee or to the ankle, respectively, in four degrees of severity (Figure 1). For varicosities of the lesser saphenous vein, three degrees of severity are differentiated, the confluence incompetence, incompetence of the venous valves from the knee to the middle of the lower leg or from the knee to the ankle.4+ as the postthrombotic syndrome. Chronic venous insufficiency is characterized by venous hypertension and subdivided into three degrees of severity: grade I in the presence of corona phlebectatica paraplantaris and stasis edema; grade II in the presence of hyperpigmentation, melanodermitis, atrophy blanche, stasis induration and hypodermitis; grade III in the presence of hyperpigmentation, melanodermitis, atrophy blanche, stasis induration and hypodermitis; grade III in the presence of healed or florid ulceration. The two most important diagnostic measures are Doppler ultrasonography and ascending pressure phlebography which complement each other (Table 3)...