Niaz Ahmed Choudhury
Current Position
Professor Visiting Professor Department of Vascular Surgery
National Heart Foundation
Venous Reflux Session

Topic: Changing Trend in the Treatment Practices of Varicose veins in a Developing Country of South Asia: Impact of Minimally Invasive Technologies


Background & Aim: Uncomplicated varicose veins belong to CEAP (Clinical, Etiological, Anatomical, Pathophysiological) clinical class 2 of the Chronic Venous Disease (CVD) spectrum. However, the condition may present anywhere in the CEAP clinical classes between 2 through 6. Though reliable data is lacking, the condition frequently presents in advanced CEAP clinical classes in the developing world with more cases in C5,6. This has profound implications in the selection of treatment modality, outcome and quality of life. Varicose veins have been traditionally treated by open surgical since the beginning of the 20th century with satisfactory long-term outcomes. The introduction of less invasive techniques at the beginning of the 21st century has brought about an interesting change in approach. Today, a patient with varicose vein is more likely to be treated by one of the endovenous techniques in the west. While the developing world particularly south Asia is catching up fast with this trend, it is still pretty much in a state of evolution. We undertook the present study to analyze the experience of a large vascular surgical group of Bangladesh to define the changing trend in the treatment practices of varicose veins. Methods: A total of 848 patients with varicose veins were treated by surgical and endovenous techniques over a period of 5 years between January 2017 through December 2021. Open Surgical operation was performed in 534 patients and endovenous technique was used in 314. Endovenous techniques included endovenous laser ablation (EVLA) and Radio-frequency ablation (RFA). Data were analyzed on an annual basis to identify the trend in treatment practices. Results: In the first 2 years of the study period (2017-2018), open surgery clearly dominated the varicose vein treatment practices though endovenous technologies were already available in the country. This started to change in 2019 when endovenous techniques made significant strides to match open surgery. Varicose vein surgery took a big dip during the Covid-19 pandemic. However, this was an era when endovenous technique sealed its dominance over the open surgical technique. Conclusion: While the minimally invasive nature of endovenous procedures is appealing, affordability is one of the major variables determining treatment choices for varicose veins in the developing countries. In these countries where hospital and personnel cost are relatively low, newer and more hardware-intensive endovenous techniques were generally more expensive compared with open surgery. With socio-economic progress, however, this has been changing in favor of endovenous procedures. Today, a patient with uncomplicated varicose vein is more likely to be treated by endovenous rather than open surgical means in Bangladesh.