History of Varicose Vein Surgery, Part 1 | Minnesota

The Origin of the word varicose comes from the Greek word, “grapelike”. It was thought to be first used as a medical description by Hippocrates in 460 BC. For over 2000 years mankind has suffered from varicose veins and has been experimenting with many ways to treat the medical problem. For many people it is also a cosmetic issue. Below is a summary of the history of varicose vein treatments and how they evolved through the years in different parts of the world.

The ancient Egyptians described varicose veins as ‘Serpentine Windings’ which were not to be surgically worked on because patients would be ‘head to the ground’. This was the first written account describing a failed attempt at surgery on varicose veins implying that the use of incisions lead to fatal hemorrhaging.

Hippocrates wrote some of the earliest medical descriptions of varicose veins. The Hippocratic Treatises, written in 460 BC took Varicose Vein treatments one step farther. He did not recommend excision but rather compression following multiple punctures. He also believed in cautery. Paulus Aegineta (AD 625-690) favored ligation of the long saphenous vein 200 years before Trendelenberg.

In a medical treatise De Medicina, a Roman physician named Celcus (25 BC – AD 14) described the ligation and excision surgeries, as well as possible complications. Galen (AD 131 – 201), also provided a description of varicose veins and promoted the use of severing the connection of the arteries to veins in order to reduce pain and avoid spreading gangrene. Celsus and Galen were possibly the first to describe ‘phlebectomies‘, a technique still used today. Celsus made multiple incisions 4 fingerbreadths apart, then touched the vein with cautery, grasped it and extracted as much of the vein as possible, double damping and dividing the vein between ligatures. Galen described making 3-6 incisions with a hook and then bandaging the leg. Roman surgeons used to carry scalpels with blunt handles that could be used for dissecting varicose veins, a procedure that was done without any form of anesthetic.

The Roman Caius Marius, who was known as a tyrant, had the varicose vein surgery of his time. After treatment on one leg he declined surgery on the other leg saying ‘I see the cure is not worth the pain’. Obviously having this surgery without anesthetic was not comfortable by any means for the patient.

Oribasius of Pergamum ( 325-405), a Byzantine physician, devoted 3 chapters of text to varicose veins. He described the details of the surgery for varicose veins of the legs included shaving and bathing the leg, followed by marking with small incisions and excising the varicose veins with 1 or 2 hooks along the leg through the small incision.

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