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In the first edition of this textbook, we lamented medicine’s extremely low level of priority given to venous disease. There has been a huge turn around in the last decade, however, as awareness of venous disease and improved treatment techniques have grown tremendously. Several reasons account for this shift. The abandonment of ligation and stripping, with the adoption of minimally invasive endovenous ablation techniques for treatment of saphenous disease have been primary driving forces in the rapid surge of venous treatment. More patients are willing to undergo straightforward ambulatory procedures rather than stripping to attain long-term improvement of leg pain and appearance. Availability of safer sclerosing agents such as polidocanol has also contributed to greatly increased interest by physicians and patients.

As the population ages, large numbers of people find themselves dealing with the medical as well as aesthetic consequences of venous disease. As they look to improve their quality of life, potential patients can access a trove of information online. Textbooks such as this one as well as on-line availability of and many open journals provide information to those seeking treatment or seeking to learn about treatment. For example, readers will have the option to instantly access this textbook. Medical professionals will even be able to search the textbook while treating patients, using devices such as Kindle or Apple iPad and iPhone, among others.

Our original motivation for writing the first edition was to share the knowledge we had gained in treating more than 14,000 patients over 16 years. Now we can expand with additional knowledge obtained from 26 years of treating over 40,000 patients with venous disease. We are grateful to have been able to play a role in the development of procedures that have significantly advanced the field of phlebology, the treatment of venous disease. We strongly feel that it is important to accurately describe these techniques in this textbook, so that they can be performed correctly with improved patient outcomes. Besides our own experience and clinical research, we have drawn on steadily expanding evidence found in the medical literature to provide a thorough yet practical information source. That is why videos of the procedures are included.

Our text is designed to assist practitioners of phlebology at all levels and in its many methods of treatment. Until Mitchel P. Goldman published his textbook of sclerotherapy in the early 1990s, there was no English language resource to help our understanding, not only of the importance of venous disease but also the science and art behind the treatment. A tremendous advance, Goldman’s textbook, remains the greatest resource in the field of phlebology, integrating the world’s literature into a single English language volume. We hope that the second edition of our textbook will continue to serve as a practical and frequently referenced guide to those physicians who wish to expand upon basic knowledge of phlebology obtained in medical school or residency or even sharpen clinical skills after practicing phlebology already.

Finally, our newest concern is widely available online misinformation on venous disease and its treatment. Internet search on varicose veins or spider veins reveals thousands of websites to patients and physicians alike. Fortunately, educational symposia are readily accessible to interested physicians and licensed health care professionals sponsored by educational organizations such as the American College of Phlebology (formerly the North American Society of Phlebology). The American Society for Dermatologic Surgery and American Academy of Dermatology offer many opportunities to learn phlebology for dermatologists and dermatologic surgeons.

To supplement these experiences, this textbook incorporates the results of years of patient treatment and study. We sincerely hope that reading this book will help to catapult your understanding and ability to deal with venous disease, and that you will use this as an ongoing reference.

Robert A. Weiss, MD, FAAD, FACPh
Margaret A. Weiss, MD, FAAD
Karen L. Beasley, MD, FAAD

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