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Neil S. Sadick - One of the best experts on this subject based on the ideXlab platform.
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Combined endovascular laser plus Ambulatory Phlebectomy for the treatment of superficial venous incompetence: a 4-year perspective.
Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology, 2007Co-Authors: Neil S. Sadick, Samuel WasserAbstract:Background: Combination endovascular laser obliteration of the greater saphenous vein in conjunction with Ambulatory Phlebectomy has become the treatment of choice for superficial venous incompetence. Objectives: The present study examines the treatment of saphenofemoral junction (SFJ) incompetence with simultaneous treatment of associated truncal varicosities by Ambulatory Phlebectomy. Methods: Four‐year follow‐up data for recurrence rate and complication profile was ascertained for 90 patients (mean age 40 years) with SFJ reflux associated with greater saphenous vein (GSV) incompetence (4–12 mm; mean 7.8 mm) and enlargement of branch varicosities as documented by Duplex ultrasound, which were treated with a combined approach of endovascular laser obliteration of the GSV (810 nm, Diomed S30) followed by hook avulsion (Ambulatory Phlebectomy) of the remaining truncal varicosities. Follow‐up by Duplex ultrasound to ensure closure was carried out at week 1 and months 1, 3, 6, 12, 24, 36 and 48. Results: A t...
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advances in the treatment of varicose veins Ambulatory Phlebectomy foam sclerotherapy endovascular laser and radiofrequency closure
Advances in Dermatology, 2006Co-Authors: Neil S. SadickAbstract:Dermatologists have played a key role in the advancement and development of new safe, noninvasive technologies that are utilized in the treatment of both cosmetic telangiectasias and larger varicose veins of medical significance. As presented in this article, major advances in sclerosing solutions, hook avulsion techniques, and endovascular RF and laser procedures have revolutionized the world of phlebology. This medical sector continues to evolve through its relevance to the ever-expanding aesthetic and aging population.
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advances in the treatment of varicose veins Ambulatory Phlebectomy foam sclerotherapy endovascular laser and radiofrequency closure
Dermatologic Clinics, 2005Co-Authors: Neil S. SadickAbstract:Several recent advances in the treatment of varicose veins have improved the safety, efficacy, comfort, efficiency, and long-term success of therapy. The advances of Ambulatory Phlebectomy, foam sclerotherapy, endovascular laser, and radiofrequency ablation with closure have made a significant positive impact on patient satisfaction. Duration of treatment and recovery is shorter, discomfort is minimized, and results are generally excellent. Studies assessing long-term outcomes are ongoing, and treatment modalities are continuing to evolve.
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Combined endovascular laser with Ambulatory Phlebectomy for the treatment of superficial venous incompetence: a 2-year perspective.
Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology, 2004Co-Authors: Neil S. Sadick, Samuel WasserAbstract:Non-invasive radiofrequency and endovascular technologies are becoming increasingly popular in the treatment of superficial venous incompetence. In conjunction with stab avulsion of truncal varicosities, these technologies have been able to address functional as well as cosmetic superficial venous incompetence in a non-invasive fashion. The present study presents a 2-year follow-up of 30 patients with combined axial incompetence of the greater saphenous vein (GSV) in conjunction with truncal varicosities treated with combination diode laser technology and Ambulatory Phlebectomy. Thirty patients (mean age 49 years) with Sapheno-Femoral Junction reflux associated with GSV incompetence (mean 9.2 x 8.5 mm) and enlarged branch varicosities, as documented by Duplex ultrasound, were enrolled. Patients were treated with an endovascular diode laser (810 nm, 14 W, continuous mode), followed by Ambulatory Phlebectomy of residual truncal varicosities. Patients were examined 3, 6, 12 and 24 months following this procedure to determine the long-term efficacy of this procedure. A 2-year closure rate of 96.8% was documented by Duplex evaluation. All 273 Ambulatory Phlebectomy vein segments were eradicated. Two cases of transient hyperpigmentation and one case of telangiectatic matting were documented. The combination of endovascular laser and Ambulatory Phlebectomy appear to be an effective and safe treatment approach for the management of combined saphenous and truncal varicose vein incompetence.
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Multifocal pull-through endovascular cannulation technique of Ambulatory Phlebectomy.
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 2002Co-Authors: Neil S. SadickAbstract:background. New treatment indications and improved technique modifications have made Ambulatory Phlebectomy increasingly popular in the management of intermediate and large truncal varicosities. objective. To describe a new technique of Ambulatory Phlebectomy that combines a multifocal incisional and endovascular cannulation approach. This study compares this newly described technique to the previously described “pulling maneuver.” methods. A double-blinded study consisting of 50 patients who were treated by the conventional pulling maneuver and 50 patients treated by the multifocal pull-through endovascular cannulation technique was conducted. This newly described technique was compared to the previously described “pulling maneuver” in terms of length of vessel avulsed per puncture site, intraoperative time, and complication profile. An average of 20 cm of diseased venous segment was avulsed in each patient subgroup. Results were analyzed utilizing the paired t test (P < .05). results. A 36% increase in vessel avulsion length per puncture site was achieved in the endovascular pull-through cannulation subgroup compared to the classic pulling maneuver population. The number of puncture sites in the 20 cm segment of veins in the classic pulling maneuver population was 4.50 versus 3.04 in the multifocal pull-through subgroup. The mean operative time was 20% less in the pull-through cannulation population versus the classic pulling technique. Side effect profiles were similar in the two patient subgroups. conclusion. The multifocal pull-through cannulation technique allows extraction of large segments of diseases varicose veins with fewer puncture sites in a more efficient fashion than previously described techniques.
H Martino A Neumann - One of the best experts on this subject based on the ideXlab platform.
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Ambulatory Phlebectomy versus compression sclerotherapy results of a randomized controlled trial
Dermatologic Surgery, 2003Co-Authors: Kees-peter De Roos, Fred H M Nieman, H Martino A NeumannAbstract:BACKGROUND. Although no randomized controlled trial has assessed the effects of either compression sclerotherapy or Ambulatory Phlebectomy, both techniques are used to treat varicose veins worldwide. We performed a randomized controlled trial to compare recurrence rates of varicose veins and complications after compression sclerotherapy and Ambulatory Phlebectomy. METHODS. From September 1996 to October 1998, we randomly allocated 49 legs to compression sclerotherapy and 49 legs to Ambulatory Phlebectomy. Our primary outcome parameters were as follows: recurrence rates at 1 and 2 years and complications related to therapy. Eighty-two patients were included, of whom 16 were included with both of their legs. The number of treated legs was therefore 98, but two patients were lost to follow-up. RESULTS. One year recurrence amounted to 1 out of 48 for Phlebectomy and 12 out of 48 for compression sclerotherapy (P<0.001); at 2 years, six additional recurrences were found, but then solely for compression sclerotherapy (P<0.001). Significant differences in complications occurring more in Phlebectomy than in compression sclerotherapy therapy were blisters, teleangiectatic matting, scar formation, and bruising from bandaging. CONCLUSION. Our results show that Ambulatory Phlebectomy is an effective therapy for varicose veins of the leg. Recurrence rates are significantly lower than for compression sclerotherapy therapy. If varicose veins persist 4 weeks after compression sclerotherapy, it can be argued that to reduce the risk of future recurrence Ambulatory Phlebectomy should be considered as the better treatment option.
Kees-peter De Roos - One of the best experts on this subject based on the ideXlab platform.
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Ambulatory Phlebectomy versus compression sclerotherapy results of a randomized controlled trial
Dermatologic Surgery, 2003Co-Authors: Kees-peter De Roos, Fred H M Nieman, H Martino A NeumannAbstract:BACKGROUND. Although no randomized controlled trial has assessed the effects of either compression sclerotherapy or Ambulatory Phlebectomy, both techniques are used to treat varicose veins worldwide. We performed a randomized controlled trial to compare recurrence rates of varicose veins and complications after compression sclerotherapy and Ambulatory Phlebectomy. METHODS. From September 1996 to October 1998, we randomly allocated 49 legs to compression sclerotherapy and 49 legs to Ambulatory Phlebectomy. Our primary outcome parameters were as follows: recurrence rates at 1 and 2 years and complications related to therapy. Eighty-two patients were included, of whom 16 were included with both of their legs. The number of treated legs was therefore 98, but two patients were lost to follow-up. RESULTS. One year recurrence amounted to 1 out of 48 for Phlebectomy and 12 out of 48 for compression sclerotherapy (P<0.001); at 2 years, six additional recurrences were found, but then solely for compression sclerotherapy (P<0.001). Significant differences in complications occurring more in Phlebectomy than in compression sclerotherapy therapy were blisters, teleangiectatic matting, scar formation, and bruising from bandaging. CONCLUSION. Our results show that Ambulatory Phlebectomy is an effective therapy for varicose veins of the leg. Recurrence rates are significantly lower than for compression sclerotherapy therapy. If varicose veins persist 4 weeks after compression sclerotherapy, it can be argued that to reduce the risk of future recurrence Ambulatory Phlebectomy should be considered as the better treatment option.
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Ambulatory Phlebectomy versus compression sclerotherapy: results of a randomized controlled trial.
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 2003Co-Authors: Kees-peter De Roos, Fred H M Nieman, H. A. Martino NeumannAbstract:BACKGROUND. Although no randomized controlled trial has assessed the effects of either compression sclerotherapy or Ambulatory Phlebectomy, both techniques are used to treat varicose veins worldwide. We performed a randomized controlled trial to compare recurrence rates of varicose veins and complications after compression sclerotherapy and Ambulatory Phlebectomy. METHODS. From September 1996 to October 1998, we randomly allocated 49 legs to compression sclerotherapy and 49 legs to Ambulatory Phlebectomy. Our primary outcome parameters were as follows: recurrence rates at 1 and 2 years and complications related to therapy. Eighty-two patients were included, of whom 16 were included with both of their legs. The number of treated legs was therefore 98, but two patients were lost to follow-up. RESULTS. One year recurrence amounted to 1 out of 48 for Phlebectomy and 12 out of 48 for compression sclerotherapy (P
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Patient Satisfaction After Ambulatory Phlebectomy of Varicose Veins in the Foot
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 2002Co-Authors: Kees-peter De Roos, Fred H M Nieman, H. A. Martino NeumannAbstract:We have also demonstrated preliminaryresults of 14 treated patients in our clinic. Recently weevaluated the results of all patients who were treatedfor varicose veins of the foot between 1996 and 2000.In our treatment strategy for varicose veins, at firstmajor points of reflux are treated, then side branchesand smaller veins. When all these varicose veins havebeen eradicated, varicose veins of the foot are treated.Follow-up after the final treatment session is generally5 days to 6 weeks. During the last control visit, pa-tients are asked if they are satisfied with the resultsand if recently any adverse events had occurred. If so,this is registered in the patient’s medical file. If pa-tients indicate that they feel satisfied with the results,no further appointments are made. They are advised,however, to return if any (other) adverse events occur.To determine long-term satisfaction with the treat-ment, a survey was started. All patients who weretreated with AMP for varicose veins of the foot be-tween 1996 and 2000 in our practice were contactedby telephone to determine whether they would partici-pate in this survey. If so, they were questioned for 10minutes using a preconstructed questionnaire. Surveyitems included the current health status of the foot, asseen by the patient, perceived recurrence, complica-tions, and how these complications effect daily life.The main question is, what determines the respon-dent’s evaluation of the health state of the foot at thetime of the survey? Is it simply the subjectively seen re-currence of varicose veins, or do one or more compli-cations provide an explanation for a more negativeevaluation of the health state of the foot? Or is it acombination of the perception of recurrence and com-plications reported that produces a positive or nega-tive evaluation of the health state of the foot?
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Muller's Ambulatory Phlebectomy and compression.
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 1998Co-Authors: H. A. Martino Neumann, Kees-peter De Roos, J. C. J. M. VeraartAbstract:background. Compression therapy will relieve patients of symptoms of venous disease, if not prevent the occurrence of complications, and is used either alone or in combination with other treatment options. objective. To describe the use of compression in the two main therapy modalities: sclerocompression and Ambulatory Phlebectomy. methods. Aim and mechanism of compression therapy are analyzed and clinical implications are discussed. results. A modification of compression therapy after Ambulatory Phlebectomy is suggested based on empirical evidence. conclusions. The use of broad compression pads after Ambulatory Phlebectomy reduces hemorrhage and enhances resorption.
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Muller's Ambulatory Phlebectomy for varicose veins of the foot.
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 1998Co-Authors: Kees-peter De Roos, H. A. Martino NeumannAbstract:background. Ambulatory Phlebectomy is an accepted therapy for varicose veins. It has also been used for ankle and foot varicosities with success although the anatomy of the venous system of the foot is poorly described in the literature. objective. To review the relevant literature on the anatomy of the veins of the foot. Also to form an opinion on safe possibilities for the treatment of foot varicosis. methods. The English, French, German, and Dutch language literature was reviewed for anatomy and treatment of varicose veins of the foot. Fourteen patients (19 feet) were treated for varicose veins of the foot with Ambulatory Phlebectomy. results. Literature concerning the venous anatomy of the foot is very limited. Venous surgery, sclerotherapy, and Ambulatory Phlebectomy have all been used for the treatment of varicose veins of the foot. The former two have resulted in serious complications. All treated patients showed excellent results with Ambulatory Phlebectomy. No serious side effects were seen. conclusions. The venous anatomy of the foot does not indicate major restrictions in the treatment of its varicosities. Ambulatory Phlebectomy is the safest and most elegant treatment option for varicose veins of the foot. Venous surgery and sclerotherapy may be used successfully in special cases only.
Mitchel P. Goldman - One of the best experts on this subject based on the ideXlab platform.
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Review of intravascular approaches to the treatment of varicose veins.
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 2007Co-Authors: Pavan K. Nootheti, Kristian M. Cadag, Mitchel P. GoldmanAbstract:This is an in-depth review article for intravascular approaches to the treatment of varicose veins. The review discusses thermocoagulation of abnormal veins performed by an endoluminal radiofrequency device or laser. The article sites specific findings and is based on our clinical experience and extensive literature search. It was found that the two techniques were less invasive, less expensive, and faster alternative to treat varicose saphenous trunks compared to ligation and stripping. Minor adjustments to the technique prevented or minimized side effects to patients. Ambulatory Phlebectomy in conjunction with treatment produced optimal long-term results.
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Autologous Vein Transplantation for Correction of Dermal Atrophic Changes
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 2002Co-Authors: Guillermo Blugerman, Mitchel P. GoldmanAbstract:background. Many filling substances are useful in correcting dermal defects and/or wrinkles. objective. To describe a novel autologous dermal implant. method. Unwanted leg/hand veins and/or varicose veins are extracted in an Ambulatory Phlebectomy technique. The veins are then either chopped into pieces and injected into the defect or inserted whole after cellular destruction with 23.4% hypertonic saline. results. Excellent correction of dermal defect has been obtained with long-lasting and possible permanent results. No complications have occurred. conclusion. Autologous vein collagen transplantation can correct dermal defects with long-lasting and perhaps permanent results.
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Tumescent anesthesia in Ambulatory Phlebectomy: addition of epinephrine.
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 1999Co-Authors: Doug Keel, Mitchel P. GoldmanAbstract:Background. The advantages of using tumescent anesthesia for Ambulatory Phlebectomy have recently been described. Previously, tumescent solutions have avoided epinephrine for concerns of toxicity given the large volume of anesthetic sometimes used. Objective. To evaluate the efficacy and safety of using epinephrine in the tumescent anesthesia solution during Ambulatory Phlebectomy. Methods. Over the course of 1 year, epinephrine in the concentration of 1:100,000 was added to the tumescent solution of patients undergoing Ambulatory Phlebectomy. A retrospective review of 94 sequential patients was performed to determine the rate of complications associated with the procedure. Results. The complication rate was considerably improved using tumescent lidocaine with epinephrine compared to a previously performed study of tumescent lidocaine without epinephrine. The rate of hematoma was decreased to nil while the rate of hyperpigmentation decreased from 3.6% to 0%. Overall, the rate of complications was improved when epinephrine was added to the tumescent lidocaine solution. Blood pressure measured every 5 minutes and heart rate measured continuously did not significantly change before, during or after infiltration of the anesthetic solution. Conclusions. Epinephrine in appropriate concentrations is clearly safe when used in the tumescent anesthetic solution during Ambulatory Phlebectomy and should be used to reduce the incidence of hematoma and hyperpigmentation.
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The Role of Lasers and Light Sources in the Treatment of Leg Veins
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 1999Co-Authors: Jeffrey S. Dover, Neil S. Sadick, Mitchel P. GoldmanAbstract:Telangiectasia of the legs occurs in 29% to 41% of women in the United States. The variation in size, flow, depth, and type preclude the possibility of a single effective treatment modality. When a systematic approach is used where feeder vessels are first surgically removed and sclerotherapy proceeds from largest to smallest vessels, 80-90% of vessels respond to a single sclerotherapy treatment. Because of the relatively modest results demonstrated with lasers and light sources and the high rate of success and the relatively low cost of Ambulatory Phlebectomy, compression sclerotherapy and superficial sclerotherapy, we generally recommend using lasers and light sources only for vessels that remain after this treatment approach. Lasers and light sources should be considered prior to sclerotherapy in patients who are fearful of needles, who do not tolerate sclerotherapy, who fail to respond to sclerotherapy, or who are prone to telangiectatic matting. Carefully monitored, controlled studies are essential to better define the role of the available laser and light sources in the treatment of leg veins.
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Transillumination mapping prior to Ambulatory Phlebectomy.
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 1998Co-Authors: Robert A. Weiss, Mitchel P. GoldmanAbstract:background. Ambulatory Phlebectomy (AP) for removal of varicose and reticular veins has become a very popular and widely used in-office outpatient technique over the past decade. One of the major obstacles of this or any other surgical vein removal technique is the technical difficulty presented to the surgeon by the disappearance of the veins to be removed when the patient is positioned horizontally on an operative table. Preoperative marking is therefore essential. objective. To investigate whether use of transillumination would facilitate and enhance marking of varicose veins prior to AP, we performed a study in which both traditional marking with the patient standing and transillumination marking with the patient horizontal were performed sequentially. methods. One hundred patients were sequentially examined prior to AP. The veins to be removed were mapped by the traditional way utilizing visual inspection and palpation in a standing position. They were then mapped in the supine or prone position utilizing a transillumination device specifically designed to enhance visualization of veins prior to venipuncture. results. In 100 out of 100 patients the markings performed using transillumination mapping most closely correlated with actual vein position during surgery. In addition, transillumination allowed for gauging of vein depth. conclusions. Transillumination mapping significantly enhances the technique of Ambulatory Phlebectomy by more accurately visualizing the course of a varicose vein prior to extraction. Furthermore, sites for incisions or punctures are more accurately guided. As a result of this experience, it is now our routine practice to perform preoperative mapping for AP by transillumination in the horizontal position.
Fred H M Nieman - One of the best experts on this subject based on the ideXlab platform.
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Ambulatory Phlebectomy versus compression sclerotherapy results of a randomized controlled trial
Dermatologic Surgery, 2003Co-Authors: Kees-peter De Roos, Fred H M Nieman, H Martino A NeumannAbstract:BACKGROUND. Although no randomized controlled trial has assessed the effects of either compression sclerotherapy or Ambulatory Phlebectomy, both techniques are used to treat varicose veins worldwide. We performed a randomized controlled trial to compare recurrence rates of varicose veins and complications after compression sclerotherapy and Ambulatory Phlebectomy. METHODS. From September 1996 to October 1998, we randomly allocated 49 legs to compression sclerotherapy and 49 legs to Ambulatory Phlebectomy. Our primary outcome parameters were as follows: recurrence rates at 1 and 2 years and complications related to therapy. Eighty-two patients were included, of whom 16 were included with both of their legs. The number of treated legs was therefore 98, but two patients were lost to follow-up. RESULTS. One year recurrence amounted to 1 out of 48 for Phlebectomy and 12 out of 48 for compression sclerotherapy (P<0.001); at 2 years, six additional recurrences were found, but then solely for compression sclerotherapy (P<0.001). Significant differences in complications occurring more in Phlebectomy than in compression sclerotherapy therapy were blisters, teleangiectatic matting, scar formation, and bruising from bandaging. CONCLUSION. Our results show that Ambulatory Phlebectomy is an effective therapy for varicose veins of the leg. Recurrence rates are significantly lower than for compression sclerotherapy therapy. If varicose veins persist 4 weeks after compression sclerotherapy, it can be argued that to reduce the risk of future recurrence Ambulatory Phlebectomy should be considered as the better treatment option.
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Ambulatory Phlebectomy versus compression sclerotherapy: results of a randomized controlled trial.
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 2003Co-Authors: Kees-peter De Roos, Fred H M Nieman, H. A. Martino NeumannAbstract:BACKGROUND. Although no randomized controlled trial has assessed the effects of either compression sclerotherapy or Ambulatory Phlebectomy, both techniques are used to treat varicose veins worldwide. We performed a randomized controlled trial to compare recurrence rates of varicose veins and complications after compression sclerotherapy and Ambulatory Phlebectomy. METHODS. From September 1996 to October 1998, we randomly allocated 49 legs to compression sclerotherapy and 49 legs to Ambulatory Phlebectomy. Our primary outcome parameters were as follows: recurrence rates at 1 and 2 years and complications related to therapy. Eighty-two patients were included, of whom 16 were included with both of their legs. The number of treated legs was therefore 98, but two patients were lost to follow-up. RESULTS. One year recurrence amounted to 1 out of 48 for Phlebectomy and 12 out of 48 for compression sclerotherapy (P
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Patient Satisfaction After Ambulatory Phlebectomy of Varicose Veins in the Foot
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 2002Co-Authors: Kees-peter De Roos, Fred H M Nieman, H. A. Martino NeumannAbstract:We have also demonstrated preliminaryresults of 14 treated patients in our clinic. Recently weevaluated the results of all patients who were treatedfor varicose veins of the foot between 1996 and 2000.In our treatment strategy for varicose veins, at firstmajor points of reflux are treated, then side branchesand smaller veins. When all these varicose veins havebeen eradicated, varicose veins of the foot are treated.Follow-up after the final treatment session is generally5 days to 6 weeks. During the last control visit, pa-tients are asked if they are satisfied with the resultsand if recently any adverse events had occurred. If so,this is registered in the patient’s medical file. If pa-tients indicate that they feel satisfied with the results,no further appointments are made. They are advised,however, to return if any (other) adverse events occur.To determine long-term satisfaction with the treat-ment, a survey was started. All patients who weretreated with AMP for varicose veins of the foot be-tween 1996 and 2000 in our practice were contactedby telephone to determine whether they would partici-pate in this survey. If so, they were questioned for 10minutes using a preconstructed questionnaire. Surveyitems included the current health status of the foot, asseen by the patient, perceived recurrence, complica-tions, and how these complications effect daily life.The main question is, what determines the respon-dent’s evaluation of the health state of the foot at thetime of the survey? Is it simply the subjectively seen re-currence of varicose veins, or do one or more compli-cations provide an explanation for a more negativeevaluation of the health state of the foot? Or is it acombination of the perception of recurrence and com-plications reported that produces a positive or nega-tive evaluation of the health state of the foot?