[Preoperative assessment of primary varicose veins]

The first step in the evaluation of a patient with primary varicose veins is a careful personal history and clinical examination. The individual advice should be based on the disturbance suffered due to the actual varicose veins, "heaviness of the legs" and the advantages and disadvantages of various therapies. The aim of an examination in any type of varicose veins is to determine their relationship to the deep and the surrounding superficial venous system. The continuous-wave Doppler method is often sufficient to examine the trunk of the long saphenous vein. Colour-coded duplex sonography is the chosen method for evaluation of the deep venous system with respect to flow feasibility and valve competence, as well as localization of deficient perforants and anatomic variations at the saphenouspopliteal junction. Phlebography is reserved for cases with inconclusive duplex-sonography results or if no duplex is available. The purpose of this exhaustive preoperative evaluation is to indicate in detail the haemodynamic and anatomic situation in the groin and in the popliteal fossa and to detect the relevant insufficient perforators. Such accurate haemodynamic assessment is the basis for an individualized operation with excellent cosmetic and functional results. Whether a reduced recurrence rate after varicose vein surgery can be shown with this extensive examination scheme has not yet been investigated in a prospective study.