Phlebology - what does the term mean?

Phlebology as seen today is one of the most multidisciplinary fields of medicine and is developing rapidly. This is influenced by many factors. We write about the details below!

Phlebology as seen today is one of the most multidisciplinary fields of medicine and is developing rapidly. This is influenced by many factors. We write about the details below!

The name 'phlebology' is derived from the Greek - the ancient word 'phlebos' (φλέψ) means vein. In brief, it is the science of the prevention, diagnosis and treatment of venous disease. Phlebology as viewed today is one of the most multidisciplinary fields of medicine and is developing rapidly. This is influenced by a number of factors. A key one is undoubtedly the fact that diseases of the venous system affect a very broad spectrum of the population (from early childhood to old age) and affect a very high percentage of it - i.e. approximately 50%. Venous disease is more common than hypertension or diabetes, which are classified as diseases of civilisation.

It is also worth emphasising that this is a very neglected field in Poland from the point of view of the education of young medical students. For this reason, in our country treatment of venous insufficiency often concerns its advanced forms (e.g. venous ulcers) or the complications themselves, such as venous thrombosis. If we add to this the aspect of rapidly ageing populations in the developed world (resulting from decreasing female fertility and lengthening human lifespan), then it is easy to understand why the treatment of venous disease and the training of FLEBOLOGISTs is so important.

FLEBOLOGY - the historical aspect!

The first mention of the differentiation of the vascular system into arterial and venous parts was made by Galen (Greek: Κλαύδιος Γαληνός, born c. 130 AD), a physician of Greek origin and talented anatomist.

The origins of modern vascular science date back to the early years of the 17th century. It was then that William Harvey (Professor of Anatomy and Surgery at St Bartholomew's Hospital in London) included the first proper description of the functioning of the bloodstream as a closed system in his treatise 'Exercitatio anatomica de motu cardis et sanguinis in animalibus (1628)'.

Modern phlebology has emerged through the mechanism of a fairly natural deepening of knowledge of the anatomy, physiology and pathology of the venous system, and through a better understanding of its development.

The venous system, compared to the arterial system, has one amazing feature - it is characterised by much greater variability. The pattern of the venous system assigned to a given patient and associated with his or her pathology can be compared to a fingerprint, explains Dr Justyna Wilczko, phlebologist at the Phlebology Clinic in Warsaw.

The development of modern phlebology is due to the tremendous progress that has been made in the diagnosis of venous disease. Diagnostic advances in turn (particularly in Doppler ultrasound) have entailed incredible progress in the development of minimally invasive treatment methods.

For more than 20 years now, most phlebology procedures have been performed on an outpatient basis. The duration of an average procedure on the venous system ranges from 15 minutes to 2.5 hours.

Modern FLEBOLOGY - what does it look like?

Modern phlebology has, so to speak, displaced classic 'hospital' surgery and has become a new field with a different, more modern view of vein disease. The combination of modern imaging diagnostics and advanced techniques for the treatment of vein disease has led to an increase in the effectiveness of treatments with a decrease in peri- and postoperative complications. Major and minor complications in total affected more than 15-20 % patients undergoing surgical vein treatment, explains Dr Tomasz Grzela.

The phlebology team working at the Phlebology Clinic on a daily basis consists of nurses and doctors specialising in many areas of medicine, including radiology and diagnostic imaging, ultrasonography, interventional radiology, internal diseases, proctology, surgery and vascular surgery. Our work is characterised by teamwork and a fully individualised treatment process that is maximally causal in nature.

At the diagnostic stage, crucial in planning the treatment of venous disease, we have been using Doppler ultrasound, intravascular ultrasound, venography techniques in CT and MRI scans, and digital phlebography for many years. A holistic assessment of the venous system allows us to treat venous disease causally with remarkable precision. The gap even from a decade's perspective seems enormous," adds Dr Cezary Szary, phlebologist and specialist in radiology and diagnostic imaging.

Who is a phlebologist?

The modern phlebologist should have a wide range of skills; he should be, as it were, an internist, a diagnostician and a surgeon in one person. A doctor dealing with venous diseases should be able to examine and qualify the patient for treatment himself. The evaluation of the venous system in Doppler ultrasound examination should include not only the veins of the lower limbs, but also the veins in the pelvis and abdominal cavity. As the experience of the doctors at the Phlebology Clinic shows, the majority of venous system pathologies have their starting point just above the fundus.

What does a phlebologist do?

Phlebologists use a variety of treatment methods in their daily practice, ranging from minimally invasive chemical techniques such as sclerotherapy or vein taping to modern intravenous thermal techniques such as laser or radiofrequency intravenous ablation. Classical surgery still has its place in the treatment of venous insufficiency. However, it is no longer as invasive surgery as it was in the days of William Wayne Babcock. Classical stripping (a surgical technique involving 'pulling out the venous trunk') first described by him in 1907 is now slowly becoming a thing of the past. This was an operation that led to a number of complications such as loss of sensation, hypersensitivity, lymph stasis, secondary phlebitis or massive haematomas.

At the Phlebology Clinic, we use an integrated system for the treatment of venous disease. Phlebologists involved in both imaging, minimally invasive treatment and surgery are involved in the diagnostic and treatment process. Often hybrid treatments are performed, involving 2, 3 or 4 people.

In our team, vein specialists work closely with interventional radiologists, performing all vascular procedures in the small pelvic and abdominal veins. W vascular workshop Using intravenous techniques, the Phlebology Clinic's procedures include venous embolisation, vein dilatation and venous unblocking using venous stents.

The most common venous diseases treated by phlebologists include:

• vascular spider veins and dilated reticular veins;
• varicose veins of the lower limbs;
• varicose veins of the intimate area;
• Pelvic venous insufficiency, including varicose veins in men;
• venous compression syndromes;
• Thrombophlebitis and deep venous thrombosis;
• venous post-thrombotic syndromes.

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