[Methods and current therapy of varicosis]

Improvements in the surgical approach to varicose veins have resulted in more elaborate and less traumatic surgery. Removing varicosities through mini-stab incisions just a few millimeters long, and individual shortening or even omitting of the stripping manoeuvre, reduce lesions to surrounding tissues and improve the cosmetic result. The condition sine qua non for tailored treatment is careful examination and classification of the varicose veins based on pathofunctional properties and less on the visible appearance. In addition to clinical examination, Doppler investigation is recommended to assess the origin of the varicosities. Evidence of a reflux from the deep into the superficial venous system is the criterion for stem varices and incompetent perforators. No leaking points of importance can be demonstrated in the other two groups of varicosities, namely in reticular varices and in spider webs. Treatment of these minor forms and of small perforators is sclerotherapy, whereas surgery is recommended for saphenous incompetence and big perforators.