Varicose veins historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The first mention of Varicose veins can be traced back to the Papyrus of Ebers. Depending on the severity, treatment ranging from compression stocking to operative procedures are available. Its treatment methods have evolved over time from procedures with very high mortality( such as stripping of veins through long incisions) to procedures that can be performed without any anesthesia such as EVLT.
Discovery
- Varicose veins probably date back to the times when we first started walking erect. Erect posture lead to increased venous pressure in lower limbs which over time lead to acute venous thrombosis, venous valvular insufficiency, and development of varicose veins.
- First known mention of Varicose Veins dates as far 1550 BCE in The Papyrus of Ebers[1].The veins were described as "tortuous, solid with many knots as if blown up by air." It advised avoiding any surgical procedures for treating it.
- Hippocrates, also known as the 'Father of Medicine' was the first to associate Varicose Veins with the ulcers[2]. He advised the use of compression bandages and cauterisation to treat the condition. At that time, the arteries and veins were both thought to carry air.
- In 1603, Jeronimus Fabricius d’Aquapendente, a professor of Anatomy was the first to give a proper description of the venous valve in his work named 'De Venarum Osteolis'.
- William Harvey(1578-1657), in his work De Motu Cordis showed that the flow of blood is unidirectional, which is due to the valves in the venous system[3]. This work is the foundation of circulatory physiology as we know it today.
- Richard Wiseman (1622-1676) was the first to use the term "varicose ulcer".
Landmark Developments in Treatment strategies
- In 1890, Friedrich Trendlenberg wrote a paper on Great Saphenous Vein ligation at the junction of the middle and lower third of the thigh. In 1896, Moore suggested some modifications to this procedure which were also backed by John Homans[4][5]
- Babcock designed a flexible internal saphenous stripper, which could pull out the vein. It can be seen as a prototype of all modern-day strippers.[6].
- Procedures of perforating veins were explored as a treatment option by various surgeons in the 20th century[7][8][9].
- In 1966, Sven-Ivar Seldinger(1921-1998), a Swedish radiologist, invented the Seldinger technique which helped the expansion of Radiofrequency Ablation techniques being used in cardiology to endovenous application.
- Alongside the development of RF ablation for the endovenous procedures, Endovenous Laser Therapy(EVLT) also developed. Bone(1999) was the first to report such use[10].
- Minimally Invasive Surgeries such as EVLT and RF ablation have become the most popular surgical procedures for Varicose veins today.
References
- ↑ Hermon, Ralph (1954). A history of medicine.
- ↑ Jones, WH (1923). Hippocrates with an English translation.
- ↑ Harvey, William (1628). Exercitatio anatomica de motu cordis et sanguini in animalibus. line feed character in
|title=at position 49 (help) - ↑ Moore W. The operative treatment of varicose veins, with special reference to a modification of Trendelenburg’s operation. Intercolonial Med. J Aust 1896;1:393-397.
- ↑ . Homans J. The aetiology and treatment of varicose ulcers of the leg. Surg Gynecol Obstet 1917;24:300-311.
- ↑ Babcock WW. A new operation for the extirpation of varicose veins of the leg. N Y Med J 1907;86:153-156.
- ↑ Linton RR (1938). "THE COMMUNICATING VEINS OF THE LOWER LEG AND THE OPERATIVE TECHNIC FOR THEIR LIGATION". Ann Surg. 107 (4): 582–93. doi:10.1097/00000658-193804000-00013. PMC 1386842. PMID 17857163.
- ↑ COCKETT FB, JONES DE (1953). "The ankle blow-out syndrome; a new approach to the varicose ulcer problem". Lancet. 1 (6749): 17–23. doi:10.1016/s0140-6736(53)92512-4. PMID 13011931.
- ↑ Hauer G (1985). "[Endoscopic subfascial discussion of perforating veins--preliminary report]". Vasa. 14 (1): 59–61. PMID 3976278.
- ↑ Bone C. Tratamiento endoluminal de las varices con laser de diodo: estudio preliminary. Rev Patol Vasc 1999;5:35-46