[Personalized treatment of varices. Indications in thirty-two cases]

During the 28th Meeting of the Collège Français de Pathologie Vasculaire, twelve experts, six angiologists and six surgeons were asked to choose a first intention treatment for 32 case reports of patients with varicose veins based on physical examinations and écho-Doppler findings. The audience made their choice simultaneously by an electronic voting system. In a large number of cases, several therapeutic options were possible. The greater saphenous vein can often be retained in first intention situations with the possibility that several years later the prognosis of the limb may depend on the presence of this vein, particularly in life threatening cases where it is needed for arterial bypass surgery. In some cases it is clear that the greater saphenous vein does not need to be removed and in others, deterioration is clearly sufficient to justify removal. In many cases, the choice between the two options is a decision to be made. Indications depend on the clinical presentation and echo-Doppler findings. The caliber of the greater saphenous vein must be determined for the entire length of the vein. Whenever possible, veins with a diameter below 8 mm should be preserved and the patients should be informed on why the choice was made. Whatever treatment has been chosen, recurrence may be observed and periodic follow-up is required.