This perspective focuses primarily on the fundamental part of phlebology, where most attention is paid to the genetic aspects of the pathogenesis of varicose vein disease and where the main breakthrough advances in this area of research are discussed. We propose a direction for further actions to replenish molecular genetic knowledge about the main drivers of pathological processes in varicose vein disease and to complete the creation of an entire picture of pathogenesis, which, in turn, may serve as a key for the development of treatment options in the future in order to translate research evidence into clinical practice.

Methods. Thirty-three patients with severe PTS were included in the study. Group 1 with 11 patients, underwent IFS stenting. Group 2 with 22 patients, had hybrid procedures: open endovenectomy from the common femoral vein (CFV) with arteriovenous fistula creation and iliac vein stenting. Pre-operatively all patients were evaluated with ultrasound and contrast venography. There was no difference between the groups for demographic data, comorbidities, and the results of imaging studies. The distribution of patients according to the CEAP classification was: C4 e 6 (55%), C5 e 3 (27%), and C6 e 2 (18%) in group 1; C4 e 13 (59%), C5 e 5 (23%), C6 e 4 (18%) in group 2. A Wallstent was used in all cases. Two stents were required in all patients in group 1, and in 16 (73%) patients in group 2. Six (27%) patients in group 2 were treated with a single stent. Patients were re-examined on day two, and one week and one year after the procedure. Low molecular weight heparins were administered in therapeutic doses for three to five days with subsequent conversion to new oral anticoagulants for one year. Results. Technical success was achieved in all patients. In the early post-operative period one case (9%) in group one and one case (5%) in group two had more that 50% residual iliofemoral stenosis. In addition, two cases (9%) in group 2 were complicated by groin haematoma, which did not require surgical intervention or blood transfusion. There were no other early complications. The cumulative primary patency rate at 12 months was 72.7% in group 1 and 81.8% in group 2 (p > .05). The venous ulcer healing rate was 50% in both groups. Conclusion. Both isolated stenting and hybrid procedures are effective and safe in patients with CVO and severe PTS. Larger prospective studies are warranted to better compare the endovascular and hybrid approaches.

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