Laser,"closure", stents and other new technology in the treatment of venous disease.

New technology is transforming our approach to venous disease. Once considered taboo for fear of causing deep venous thrombosis, surgical or endovenous intervention in the deep venous system is now known to be safe. Newer techniques allow minimally invasive procedures, many carried out on an outpatient basis. Traditional conservative regimens to treat acute ilio-femoral DVT are yielding to more aggressive interventional approaches to minimize the high incidence of postthrombotic syndrome with the former. Stent technology can safely and effectively relieve many of the disabling symptoms of chronic venous obstruction. Stent patency is high and morbidity low. Knowledge of venous pathophysiology has also advanced, though much remains to be learned. The beneficiaries are the large patient population with DVT and chronic venous insufficiency, which is estimated to be at least three times as large as patients with arterial disease. Unlike arterial disease, venous pathology afflicts the younger working age population in large numbers at enormous direct and social costs. In the older patient, deep venous disease is common, but seldom suspected. The symptoms are often ascribed to systemic causes. A thorough venous investigation is the key to proper diagnosis and treatment. Often, a minimally invasive procedure such as EVLT or stent insertion can offer surprising symptom relief with significant improvement in the quality of life during the twilight years.