[Current role of surgery in chronic venous diseases]

Non invasive explorations of chronic venous disease, particularly echo-doppler techniques, have greatly improved our understanding of the underlying pathophysiological mechanisms. The findings of the physical examination are however still the basis of all indications for surgery. The most frequently performed procedures involve treatment of superficial venous insufficiency. Classical stripping of the large superficial veins with crossectomy has largely been replaced by more individualized procedures. The long-term effectiveness of certain revolutionary methods such as the Chiva procedure have not yet been proven. Indications for surgery of the perforating veins is a matter of debate but could benefit from the development of less traumatic endoscopic techniques. Surgery of deep vein insufficiency is another field of development. The follow-up in recently reported series is now long enough for an assessment of the therapeutic value of these procedures. Deep vein surgery has given a variable degree of success for post thrombotic syndrome but its effectiveness is proven in Primary deep vein insufficiency.