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vascular professional | issue 01 · 2021                                                     original article










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


            1  Veins International Congress Vienna (Virtual)
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            on 21  November 2020
                       st


            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-
 th
               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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