Variability in the management of superficial venous thrombophlebitis among phlebologists and vascular surgeons.

Introduction: This study aimed to compare management patterns of patients with superficial venous thrombophlebitis (SVT) among phlebologists and vascular surgeons.

Methods: A survey was provided to practitioners who attended the American Venous Forum meeting in 2011. Statistical analysis included descriptive statistics, unpaired t tests, and Friedman's test for correlation.

Syncope for phlebologists.

Emergencies during phlebology procedures are rare. Nonetheless, a phlebologist needs to be prepared to manage such a situation (like syncope due to anaphylaxis) if it occurs, to distinguish a true emergency from a more benign scenario (like vasovagal syncope), and even to manage an emergency unrelated causally to the procedure itself (like a heart dysrhythmia which happens to occur during sclerotherapy). The focus of such preparations should be actions and information which affect patient outcomes.

Treatment of primary varicose veins has changed with the introduction of new techniques.

New technologies have produced a revolution in primary varicose vein treatments. Duplex ultrasound is now used for preoperative diagnosis, postoperative surveillance, and during many procedures. Ultrasound has also altered our understanding of the pathophysiology of chronic venous disease.

CHIVA.

Based on a theoretical hemodynamic model, CHIVA (conservative hemodynamic cure for venous insufficiency) is an ultrasound-guided, minimally invasive surgical strategy performed under local anesthesia for the treatment of patients with varicose vein disease. After careful duplex mapping, the surgeon performs flush ligation procedures at the proximal origin of key points of reflux while meticulously maintaining superficial venous drainage to prevent varicosity recurrence. The saphenous veins are preserved.

Management of secondary varicosities.

Physicians have several options to treat varicose veins that remain after successful axial vein ablation. Foam sclerotherapy is effective for all sorts of veins, but may become less effective and have a higher risk of complications when treating large diameter veins. Endovenous laser and radiofrequency ablation can be used to treat nontortuous tributaries.