Management Strategies in Patients with Chronic Venous Disease

The aim of this thesis was to develop an algorithm for personalized management decisions in patients with CVD (C2-C6). In order to do so, we first aimed to investigate the specificity of venous symptoms for the diagnosis of CVD, because presence of venous symptoms is an important criterion to decide whether or not to treat a patient (chapter 2).

Our second aim was to evaluate the durable effects of three frequently used treatment techniques (i.e., HL/S, EVLA and UGFS) because current phlebologic EBM is largely based on short- or mid-term follow-up studies (chapter 3).

Our third aim was to assess the elasticity of the ST by assessing diameter change between standing and lying position, which we called postural diameter change (PDC) of the ST (chapter 4). The degree of PDC might become a useful additional tool to estimate severity of CVD and may help physicians to decide whether or not to ablate the ST in a particular patient with CVD. In chapter 4, we also reported our research on properties of the ST by studying focal dilatations of the ST and their association with patient and DUS variables.

Our fourth aim was to determine patient, DUS and device specific predictors for recanalization following EVTA (chapter 5).

Our final aim was to evaluate how patient and DUS related variables influence treatment strategies in CVD patients (C2-C6) and eventually introduce a management strategy algorithm (chapter 6). Ideally, the results of this thesis should contribute to the improvement of personalized medicine in phlebologic practice.