Fig. 1.1
Friedrich Trendelenburg (1844–1924)
Madelung and William Moore were other prominent personalities who contributed to the surgical treatment of varicose veins [15]. William Moore can be credited with outpatient treatment of varicose veins since he popularized the surgery for varicose veins under local anesthesia. The credit for introducing the technique of stripping is shared by Mayo (1904), Keller (1905), and Babcock (1907) [16–18].
One of the most highly disfiguring and horrendous procedures for the treatment of varicose veins practiced in 1908 is called the Rindfleisch-Friedel operation [19]. This consists of cutting a deep spiral gutter to deep fascia that wraps round the leg six times! This spiral gutter brings to view a large number of superficial veins. All of them were ligated. The wound was left open to heal by granulation [20].
Nonsurgical treatment by injecting sclerosing substances was in practice in the mid-1920s. Sclerotherapy almost totally overshadowed surgery till Linton, in 1938, introduced the concept of radical varicose vein surgery [21]. This consists of interruption of the points of venous reflux along with stripping of the internal and external saphenous veins. The procedure includes ligation of insufficient perforating veins and staggered resection of varicose tributaries.
Pathophysiology of DVT, post-thrombotic syndrome, and leg ulcers were extensively described by Homans in 1917. The role of recanalization of the thrombus with valve destruction was identified by him for the first time. The technique of microphlebectomy was introduced by Muller in 1966 [3].
In 1966, Henschel and Eichenberg discovered polidocanol [6, 17]. Many other chemicals were used for sclerotherapy till such time with poor results. Polidocanol has revolutionized sclerotherapy. Initially it was used as simple injections. The modern technique of ultrasound-guided foam sclerotherapy has revolutionized varicose veins treatment making it more and more minimally invasive [22].
Conrad Jobst (1930), a successful engineer, who manufactured toothbrushes, had refractory venous ulcers. He understood that the hydrostatic effect of pooled blood in the leg caused symptoms in venous disease. Jobst introduced graduated compression stocking for control of his own disease. At present, graded compression stockings form one of the most effective treatment options for CVD.
Evolution of Diagnostic Procedures
Two major landmark events for diagnosis of venous disorders were the introduction of phlebography and duplex ultrasonography.
The credit of introducing phlebography in human beings for the first time goes to Berberich and Hirsch, Sicard, and Forestier in the 1920s [6, 23]. Dos Santos in 1938 described ascending venography for the diagnosis of DVT [23].
The principle of Doppler for the evaluation of venous diseases was introduced by Sigel and Colleagues (1967) [6]. Duplex ultrasound, the current gold standard for the assessment of vascular disorders, was introduced by Szendro, Nicolaides, Myers, Malouf et al. in 1986 [6].
Other major events in the diagnosis of venous disorders are listed in Table 1.1.
Table 1.1
Landmark events in diagnosis
Year | Scientist | Invention |
|---|---|---|
1948 | Pollack and Wood | Dynamic measurement of venous pressure |
1953 | Whitney | Impedance plethysmography |
1960 | Hobbs and Davies | Detection of thrombi by radioactive iodium |
1968 | Dahn | Strain gauge plethysmography |
1969 | Webber | Detection of thrombi by radioactive technetium |
1971 | Rosenthal | Radionuclide venography |
1973 | Norgren and Thulesius | Foot volumetry |
1973 | Cranley | Phleborheography |
1979 | Abramovitz | Photoplethysmography |
1987 | Van Rijn | Air plethysmography |
Evolution of Treatment for Chronic Venous Insufficiency
Bypass surgery for deep venous obstruction was performed for the first time by Palma and Esperon in 1958. They described the technique of a crossed femoro-femoral graft for iliac vein occlusion [24]. Surgery for incompetent perforators in the treatment of CVI was pioneered by Robert Linton. Linton’s techniques were further modified by Cockett and Felder. The subfascial endoscopic perforator surgery (SEPS) introduced in 1985 by Hauer and Sattler transformed an extensive radical open intervention to a minimally invasive procedure with early recovery [25].
Reconstruction of deep veins as a treatment for CVI was introduced by Robert Kistner in 1968. He described the technique of internal valvuloplasty [26]. This opened the floodgate and many more novel procedures were introduced for reconstruction of valves in the deep veins. Raju modified the Kistner technique and popularized the supravalvular approach for repair. The technique of external valvuloplasty was also introduced by Kistner and Ferris. Taheri and team from Buffalo pioneered the technique of axillary segment transfer. This was a major breakthrough since the technique could be used for post-thrombotic limbs also. Guarenea in 1984 published his results of external banding of deep veins using a Dacron sleeve. A modification of this technique using silastic cuff was introduced by Jessup and Lane in 1988. Dalsing in 1999 tried cryopreserved venous segments for clinical use. Transcommissural valvuloplasty was popularized by Raju in 2000.
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