Hi, Dr. Adam Goldman of the Metropolitan Vein and Aesthetic Center. I’m here today to talk to you about the history of vein disease and vein treatment, the evolution from invasive to minimally invasive vein treatments, and also a bit about the laser, radiofrequency, and other modalities that we use.
So let’s go ahead and get started.
Early History of Varicose Veins
Let’s first talk about the history of varicose veins before the Common Era.
The first mention of varicose veins is in 1550 BCE in a document called the Ebers Papyrus, which was found in Egypt. Then again in 400 BCE in the writings of Hippocrates.
The next major invention was in 270 BCE. It is documented that the Egyptians invented forceps, and they could then effectively clamp blood vessels to perform procedures safely and effectively.
The first real treatment that we have in the history books is actually in 0 BCE by the emperor Augustus. He underwent treatment of one leg, most probably a phlebectomy. He had a lot of pain and actually refused to do the other leg, saying that the treatment was worse than the disease.
Developments After the Common Era
Next, let’s talk about the history after the Common Era.
A major development initially happened with a gentleman named Galen. He was a Greek physician, surgeon, and philosopher. He was born in 129 CE and practiced around 162 CE, treating several Roman emperors. He had been performing phlebectomies, and the technique he used back then is not that different from today.
Then, in 600 CE, we have documentation that a Greek surgeon ligated the greater saphenous vein, another major advance in the treatment of venous disease.
In 1485, Leonardo da Vinci conducted extensive anatomical work, which furthered our understanding of venous disease and many other parts of anatomy. He was a real pioneer in that respect.
17th to 19th Century Advancements
This brings us to the 17th through the 19th century, where physicians began attempting minimally invasive treatments using injections of iron and iodine. They later realized this was a poor treatment, and it was abandoned.
In the 19th century, a doctor named Friedrich Trendelenburg pioneered what we now use as the Trendelenburg position when treating veins. He performed ligation of the saphenofemoral junction, introducing the idea of more permanent treatment of the feeding veins, which is foundational to modern treatment methods.
20th Century Breakthroughs
Moving into the 20th century, it was realized in the early 1900s that vein ligation alone was not an effective strategy because the body would grow new veins around the closed vein.
Vein stripping was then developed around 1905 to 1907, along with several tools still used today.
However, a major downside of vein stripping is the need for general anesthesia and prolonged recovery time.
A major breakthrough came in the 1980s and 1990s with the development of ultrasound. This allowed physicians to visualize anatomy before treatment and later use imaging during procedures.
Around 1998, the first endovascular minimally invasive closure was performed using radiofrequency. Around that same time, Navarro and Bone performed endovascular laser vein ablations using an 810-nanometer diode laser and published their report in 2001.
In 2005, a landmark trial showed that using radiofrequency to close the greater and lesser saphenous veins provided long-term results and was safe and effective. This marked the true beginning of modern minimally invasive treatments.
Modern Treatments and Recent Innovations
More recently, in 2015, VenaSeal was approved by the FDA. This treatment uses a medical adhesive (glue) as a different modality to close veins affected by venous disease. While it does not use energy, it achieves a similar outcome.
In 2022–2023, Varithena received FDA approval. This was not entirely new, as polidocanol foam had already been used for treating superficial veins. However, a landmark study led to FDA approval, making it a standard treatment option today.
Final Thoughts
As you can see, venous disease has been known about and treated for many centuries. However, it is in the last 20 to 50 years that treatment has improved to the point where it is now standard, minimally invasive, and highly effective.
Today, procedures are performed easily in the office with minimal risk, and patients can return to their normal activities quickly. The advancement in treatment has been truly remarkable.
About Metropolitan Vein and Aesthetic Center
At the Metropolitan Vein and Aesthetic Center, we perform all minimally invasive treatment modalities.
If you are suffering from venous disease, please come see us for a consultation. You can find us online or on Instagram. We have two locations, one in Manhattan in Inwood and one in Corona, Queens.
We would be happy to evaluate and assist you with any venous concerns, whether medical or cosmetic.
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