Techniques in the Surgical and Catheter-Based Treatment of Venous Disorders.

Description

The surgical management of venous disease is filled with dichotomies. Procedures span the spectrum from the most mundane saphenous vein stripping (one of the first procedures I did as an intern) to sophisticated central venous reconstructions. Venous surgery tends not to be glamorous, playing second fiddle to arterial reconstruction but frequently is technically more demanding and very dependant on meticulous technique. Diagnosis may be straightforward as in identifying lower extremity varicosities or extremely challenging as in confirming a true thoracic outlet syndrome. Though responsible for a great deal of morbidity in the population as a whole, it receives less attention than it deserves from caregivers. The patient who presents with DVT now frequently is sent home immediately on injectable anticoagulants “per protocol,” deceptively minimizing the long-term sequelae of chronic venous stasis disease. Venous disease is the Rodney Dangerfield of surgery, getting little respect. This is a mistake as Dr. Illig and his colleagues capably illustrate in this issue of Operative Techniques in General Surgery. They show the numerous surgical options available to treat various venous disorders and the evolving nature of those treatments. This broad reaching issue spans newer treatments for the lowly varicosity all the way to the complexities of vena cava and subclavian vein reconstruction. Just as tackling venous disease takes a special kind of surgeon with a special commitment to succeed, so did Dr. Illig take on the challenging task of organizing this issue, something that a less motivated individual might shy away from. He has recruited a truly elite group of surgeons to create this unique issue on this often-minimized surgical topic. I thank him and his contributors sincerely for a valuable compendium that brings to the forefront the surgical options available to the patient with venous disease.

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