Korea treated 1.87 million people for chronic venous disease in eleven years. Open surgery fell by a third while catheter ablation rose forty-two-fold

Varicose veins are among the most visible conditions in medicine and among the least discussed in evidence terms. Korea has eleven years of national claims data on them, and the picture it shows is of a disease being treated more often, treated differently, and increasingly caught before it does its worst damage — with one of those three claims weaker than it looks.

How many, and how the treatment changed#

A serial cross-sectional study published in Annals of Surgical Treatment and Research analysed Health Insurance Review and Assessment Service records for chronic venous disease from 2010 to 2020. Over that period 1,867,307 patients were managed, and the annual count rose by half.

Every one of those changes was statistically significant. The direction of travel is unmistakable: more patients, fewer operations, far more catheter-based procedures.

Reading a forty-two-fold rise carefully#

A risk ratio of 41.81 is the largest number in the study and the one most likely to be quoted without its denominator. It starts from 290 procedures nationally in 2011 — a technique barely in use. Ending at 12,126 is a genuine transformation of practice, and it is still fewer procedures than the 21,792 open operations Korea performed in the same year.

So Korea has not replaced surgery with ablation over this decade. It has added a large ablation practice alongside an open-surgery practice that shrank by a third and remains the larger of the two.

The ulcer figure, and what it does not prove#

The most appealing number in the study is the fall in venous ulcers, from 3.1 percent of patients to 1.7 percent. A venous ulcer is the end stage of chronic venous disease — the outcome everything else exists to prevent — and halving its share looks like a system getting better at prevention.

Most Koreans do not know what this is#

A companion survey published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders put the same disease to the public. Between May and June 2020 it surveyed 900 Korean adults aged 20 to 64 online and interviewed 124 patients presenting with symptoms.

Awareness was low: most respondents recognised chronic venous disease only as a name. Awareness was higher in women, in people over 29, and in those with more education and higher income — the familiar gradient, and the reason low awareness is not distributed evenly across the people who get the disease.

The sharpest figure concerns the people who did act. Of 53 respondents who went to a hospital with suspected venous symptoms, a diagnosis was made in 30.2 percent. Roughly seven in ten presented and left without one.

Among patients who did have chronic venous disease, about 60 percent said the physical symptoms — not the appearance of their legs, and not the emotional effect — were what damaged their quality of life. That is worth stating plainly in a field where the condition is routinely discussed as a cosmetic one.

What claims data can and cannot show#

These are administrative records. They count diagnostic codes and billed procedures across an entire insured population, which is their strength, and they carry nothing about symptom severity, ultrasound findings, why any individual treatment was chosen, or whether it worked. The rise in patient numbers cannot be separated into more disease, more diagnosis and more willingness to seek care, because a claim records only that someone was seen.

What they establish is the shape of Korean practice: a large and growing patient population, an open operation in retreat but still dominant by volume, and a catheter-based alternative that went from almost nothing to a substantial share of treatment inside a decade — in a public that, on its own account, mostly does not know the disease exists.