MUDr. Libor Dvořáček: Microinvasiveness of surgery involves not only the method but also targeted solutions to varicose vein sources
Varicose veins, or chronic venous insufficiency of the lower extremities, are primarily a health issue, not purely a cosmetic one. This is because they are associated with the risk of complications that necessitate long-term therapy and complex treatment of these issues. As MUDr. Libor Dvořáček, the head physician of the Vasmedic Clinic, mentions in our brief interview on this topic, the approach of health insurance companies and the Ministry of Health has fortunately been changing in favor of day surgery – that is, microinvasive and much gentler surgery.
Can you describe your typical patient treated for varicose veins – for example, regarding age, gender, and severity of chronic venous insufficiency (CVI)?
Characterizing a typical patient with varicose veins is not easy as patients with varicose veins span across all groups. However, it can be said that it is predominantly women between the ages of 35 and 55, at the stage of CVI CEAP C2–3.
How many patients with this condition come through your clinic annually?
Our clinic is very young and after a year of opening, it is very difficult to determine the average annual number of patients with this condition. Since opening, however, we have treated nearly a thousand patients diagnosed with CVI.
If you had to further scale these patients by type of chosen treatment – in how many cases (so far) do you recommend only conservative treatment?
Conservative treatment – and I definitely do not mean just pharmacotherapy, but also compression treatment of the lower extremities – I recommend to all patients. But if the question was meant to ask how many patients are treated only conservatively, then it is approximately 40% of patients.
Which medications do you most frequently indicate?
We most frequently recommend drugs containing flavonoids. These are proven effective substances with long-term experiences both in chronic and acute phases of the disease.
In the context of so-called day surgery, where the patient goes home on the same day as the procedure, you offer various surgical options. To what extent can the patient choose among them?
The patient who comes to us is examined sonographically and based on anamnesis data, we then jointly decide on the type of possible surgery. At our clinic, we offer all available methods for both primary issues and recurrent problems. We provide customized microinvasive procedures even for patients repeatedly operated on in other facilities and with persistent varicose veins.
For patients, it may be very difficult to navigate through the offered methods – laser, radiofrequency, sclerotherapy, and others. Do they differ in terms of recovery and outcome?
Recovery from microinvasive surgical procedures is very short. We always give the patient enough time to understand their individual situation and jointly choose the appropriate procedure according to their condition.
Do you combine multiple methods in one patient?
Very often, our surgeries are a combination of several methods due to a very individualized approach. It is not appropriate to generalize and solve cases uniformly – this leads to quick recurrences and makes further solutions more complicated.
Is there currently a dominant method at your clinic, or is there something like a current trend?
I adhere more to the views of experienced surgeons that it is not so much about a trend, but about the correct indication for surgery and a gentle accurate way of performing it. Microinvasiveness of the surgery lies not only in the method but also in targeting varicose veins, ideally with continuous sonographic navigation. We perform all types of surgeries only under local anesthesia, even for patients with complicated postoperative recurrent varicose veins.
Is there perhaps a method that is currently not available in the Czech Republic, but which allows achieving exceptional results? What might that be?
Exceptional results can be achieved by an exceptional human approach to each patient individually. Any method can achieve this if it is in the hands of an exceptional doctor.
Wearing compression stockings is associated with surgical procedures. But what if you have a patient with varicose veins who does not want or cannot wear them for some reason?
With the development of modern compression stockings and a modern approach, the healing time and the necessary time for wearing compression after procedures are significantly shortened. It is now a matter of days, and if we choose the right type and size of stockings, they bring significant benefits that patients appreciate.
What is the average amount a patient pays for varicose vein removal? Are some methods covered by insurance?
Currently, only the classic surgery associated with a long recovery is covered by insurance. For microinvasive procedures, the cost is on average around 20,000 crowns.
Is there any chance that the reimbursements will change in the future? After all, it is not just a cosmetic issue, but primarily a health problem...
It is definitely a health problem; a purely cosmetic issue is very rare. Even pain or a feeling of heaviness are signs of overloading the venous system of the lower extremities with a risk of complications that lead to long-term treatment and more complex solutions. The approach of health insurance companies and the Ministry of Health has fortunately been changing in favor of day care in recent times.
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