Page 7 - vascular professional 01_2021_eMagazine

vascular professional | issue 01 · 2021 original article

Summary of 35 International Várady Workshop
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for Phlebology, Lymphology and Angiology -

1 Veins International Congress Vienna (Virtual)
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on 21 November 2020
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BY PROF. H.C. DR. ALEXANDER FLOR,

Private Clinic Döbling, Vienna, Austria

DR. ANDREAS F. BALOGH,
Hospital Floridsdorf, Vienna, Austria

The online congress was started off by Prof. Dr. Zoltán A brief excursion on wavelengths used in endovenous
Várady, developer and thus eponym of the well-known obliteration was given, the now most commonly used
and widely applied technique to treat varicose veins via wavelength is 1470nm because it is superior when it
miniphlebectomy, according to Várady. In his lecture Prof. comes to absorption by water in the vascular walls and
Dr. Várady presented his technique, correct use of the blood components.
instruments he developed and its advantages. Miniph- Prof. Dr. Maurins’ wavelength of choice is 1940nm
lebectomy acc. to Várady is performed on preoperatively though, since it provides an absorption 4 times higher
marked varicose veins under local anesthesia through than the widely used 1470nm. This results in less carbo-
small incisions, using microscalpels. The veins are then nisation and less sticking to vascular walls during treat-
prepared using the Várady spatula and extracted by using ment and is also appropriate for varicose veins of greater
the Várady hook and clamps. Correct use of the spatula diameter. The higher wavelength has been shown to also
and application of local anesthesia facilitates the prepa- reduce pain in the patients. The fi bers used are radial
ration of long segments of the vein thus greatly reducing 2-ring probes at 8W for veins with diameters >8mm and
the number of incisions needed to extract them. Accor- swift fi bers at 6W for smaller veins.
ding to Prof. Dr. Várady, this simple, low eff ort procedure A crucial step to secure optimal outcomes is planning
gains excellent results both medically and cosmetically the surgery tailored to the patient. This involves ultra-
without scarring, bleeding, long hospitalization or post- sound and having a strategy on how to treat diff erent
operative treatment. Compared to sclerotherapy there is segments of varicose veins in the patient, varying in ap-
no risk of pigmentation, induration and necessity of pain- plied laser energy.
ful incisions in case of thrombotic convolutes. In order to perform crossectomy through his endove-
Also, as part of the concept of Várady, removal of in- nous approach, Prof. Dr. Maurins starts ablation proximal
suffi cient tributaries is benefi cent for insuffi cient trunk of the preterminal valve rather than 2.5cm distal of the
veins which is why according to his concept the saphe- saphenofemoral junction. The latter approach would lea-
35 International nous trunk is left intact for potential recovery. ve insuffi cient side branches inserting between pretermi-
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Among panelists, however, this approach is up for dis-
nal and terminal valves untreated. Tumescence is placed
cussion, the general consensus is in favour of a combined
between the great saphenous vein and femoral vein in
Várady Workshop in Vienna approach consisting of obliteration of insuffi cient saphe- order to optimize the insertion angle.
Treating the side branches, Prof. Dr. Maurins favours
nous veins and miniphlebectomy in most patients.
Following Prof. Dr. Várady, Prof. Dr. Uldis Maurins of a two-step approach, separating endovenous obliteration
Dr. Maurina Vein Center in Latvia presented how endo- from miniphlebectomy. This is due to his observation of
laser and miniphlebectomy are done in his clinic. tributaries resolving themselves in 80% of patients thus
reducing trauma and unnecessary phlebectomies.

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