[Varicoses: should invasive treatment be standard?]

Abstract

The new Dutch multidisciplinary guideline for diagnosis and treatment of venous pathology deals with diagnosis and treatment of varicosis, new surgical techniques in obstruction or insufficiency of the deep venous system, crural ulcers and compression therapy with hosiery or bandages. It also describes classical and new techniques for surgery and endovascular obliteration of varicose veins and evidence based criteria for choosing the optimal therapeutic strategy. Although the working party puts much emphasis on new invasive therapies it neglects to describe the results of conservative therapy such as therapeutic elastic stockings and lifestyle advice including weight loss, exercise and avoiding standing in upright position for long periods. The general advice to choose invasive therapy above conservative therapy except where the result of previous invasive therapy has been insufficient or where invasive therapy is not an option, seems somewhat over the top. Modern elastic stockings are more acceptable as they look good, are transparent and have all kinds of elegant extras and the modern fabrics are comfortable for the wearer. Class I compression stockings have been shown to be effective in uncomplicated cases and are easier to handle than class II, especially for the elderly.