Short Biography Information
Prof. Sergio Gianesini is a surgeon, molecular vascular biology PhD and professor at the University of Ferrara (ITALY) and at the Uniformed Services University of Health Sciences (Bethesda, USA). He is the president of the World Union of International Phlebolymphology (WUIP) and the emeritus president of the venous-lymphatic World International Network (v-WIN) foundation. He is associate Editor of International Angiology Journal and editorial board member of 9 international scientific journals dedicated to vein and lymphatic care. He is the principal investigator of the global Real World Data v-REGISTRY project. He is the project lead of the clinical governance document on vein-lymphatic care (V.A.L.I.D. project) and the chair of the Le.G.athering Global Project: a worldwide initiative dedicated to the holistic approach to leg care, to be hosted in Dubai on December 17-19, 2026 (https://vwinfoundation.com/legathering/).
Interview questions:
Can you describe a particularly difficult case you have encountered in your practice as a phlebologist and how you dealt with it?
In the specific context of surgical phlebology addressed by the question, I recall a particularly challenging case involving recurrent saphenofemoral junction incompetence following a traditional high-tie ligation in a severely obese patient with active venous ulceration. The patient also presented with a multitruncular incompetent Hunterian perforator and was unwilling to undergo further treatment in the operating room. The primary challenge was not the surgical act itself, rather the comprehensive analysis of the reflux pattern, the selection of the most appropriate strategic and technical approach, and the need to improve patient compliance, particularly with compression therapy. This case stimulated my research interest in the etiology of saphenofemoral junction recurrence (Gianesini S. Femoral vein valve incompetence as a risk factor for junctional recurrence. Phlebology. 2018 Apr;33(3):206-212), true perforator vein incompetence (Gianesini S. Comparison Between Duplex Ultrasound and Multigate Quality Doppler Profile Software in the Assessment of Lower Limb Perforating Vein Direction. Eur J Vasc Endovasc Surg. 2018 May;55(5):688-693) and hybrid surgical–foam treatment strategies (Gianesini S. Mini-invasive foam sclerotherapy-assisted ligation versus surgical flush ligation for incompetent sapheno-popliteal junction treatment. Phlebology. 2019 Oct;34(9):604-610). Ultimately, the balance between patient preference and surgical judgment led to an exclusively physician-compounded sclerotherapy approach. While effective, this strategy required multiple treatment sessions and likely resulted in slower ulcer healing than might have been achieved with alternative options, such as flush placement of a titanium clip at the femoral vein neo-junction, targeted reduction of the incompetent truncal vein, and/or injection of a high-quality, nitrogen-free microfoam.
What new developments or advances in venous surgery are you most excited about, and how do you think they will improve outcomes for patients?
Undoubtedly, the most exciting and meaningful advancement in venous surgery and in vein care more broadly has been the growing emphasis on evidence-based practice and robust clinical governance. As early as 2019, the need to improve methodological rigor and harmonize guidelines was highlighted by a global document that examined similarities and discrepancies among international recommendations(Gianesini S. Global guidelines trends and controversies in lower limb venous and lymphatic disease: Narrative literature revision and experts’ opinions following the vWINter international meeting in Phlebology, Lymphology & Aesthetics, 23-25 January 2019. Phlebology. 2019 Sep;34(1 Suppl):4-66). In 2023, a large international initiative involving 71 organizations across 83 countries further underscored the importance of counteracting misinformation in phlebology and lymphology. The relevance of this effort was recognized by the United Nations Communication Committee, reflecting the global significance of the issue (Gianesini S. Fake-news-free evidence-based communication for proper vein-lymphatic disease management. Int Angiol. 2023 Apr;42(2):89-189). In 2025, the first institutional clinical governance document providing recommendations for appropriate and affordable vein and lymphatic care was released, with the involvement of ministries and leading institutions from around the world. (Gianesini S. Multi-specialty recommendations for the appropriate and affordable lower limb vein-lymphatic disorders managament. Int Ang J 2026:1(45):1-61). This is truly an exciting and much-needed period for phlebology and lymphology, marking a decisive shift away from commercially driven claims toward solid evidence, promoted within the highest institutional frameworks for the benefit of patients requiring vein and lymphatic care.
What advice would you give to patients who are considering vein surgery, and how can they prepare for the procedure and recovery?
The first and most important recommendation is to avoid reliance on sensational claims, technology-only approaches, or promises that seem too good to be true. Venous disease involves both macroscopic and microscopic pathology; therefore, interventional procedures are as essential as microcirculatory management through conservative strategies, such as validated venoactive drugs and certified compression therapy, while never overlooking the positive impact of an appropriate lifestyle. I would also encourage patients to consider the metaphor of a house pipe: it may need proper repair, but it must also be embedded within a sound wall (the musculoskeletal component) and driven by an efficient pump (lifestyle and occupational factors).
In your opinion, what distinguishes phlebology from other surgical specialties, and what attracted you to this field?
Phlebology is currently practiced as a subspecialty within several different medical disciplines. As a surgeon, I look to the presidents of the World Union of International Phlebo-Lymphology who preceded me and note that they came from a wide range of specialties, an observation that reflects the global, multispecialty nature of this field. Over the decades, phlebology has evolved into a compelling translational discipline, requiring both basic science and advanced clinical expertise at a level of detail that now compels our global community to consider the establishment of a dedicated specialty. This evolution is both timely and necessary, in order to ensure appropriate training and high-quality care for healthcare professionals and for patients requiring vein and lymphatic treatment. The academic interest toward such fascinating now-to-be-considered-Specialty as well as the charming challenges its heterogenous clinical manifestation offers led me to this field, without a single doubt in its choice.
How do you see the future evolution of phlebology and what role do you think technology and innovation will play in this evolution?
Phlebology has long been evolving in close parallel with Lymphology. As aptly described by Professors Partsch and Lee in 2014, the two disciplines represent a true “family affair.” It is increasingly evident that Phlebology is not merely about eliminating venous reflux, but about restoring effective lower-limb drainage and overall limb function within the context of the whole person. The concept of the “person” is the foundation of “personalized” medicine, which should aim to deliver tailored therapeutic strategies rather than purely ablative treatments. In this perspective, the Venous–Lymphatic World International Network Foundation is actively collaborating with the global community through the Le.G.athering project, which brings together all professionals involved in leg care across multiple specialties. Whoever wants to join is more than welcomed (https://vwinfoundation.com/legathering/). It includes obstetrics and gynecology for pelvic disorders, orthopedics, rehabilitation, and oncology for edema and thrombotic risk management, sports and occupational medicine and nutrition for lifestyle optimization, dermatology for wound care and aesthetic phlebology, cardiology for cardiovascular risk management, always in close synergy with family medicine. Within this framework, technology and innovation should enable healthcare professionals to improve both anatomical outcomes and patient-reported results, while recognizing that the true game changer lies in strategy rather than technique alone. A deep understanding of pathophysiology and optimal hemodynamic management remains the essential first step toward meaningful improvement in Phlebology outcomes. Technology, in this context, also encompasses digital tools, including the systematic collection of real-world data and the integration of artificial intelligence. This approach is clearly reflected in recent findings from the global V-Registry project (https://v-registry.com), which have challenged traditional assumptions regarding the relative weight of specific risk factors and highlighted the necessity of global collaboration to properly evaluate the influence of ethnicity and lifestyle, even on the performance of the most advanced devices. In conclusion, the future evolution of Phlebology can only be achieved through close collaboration among multiple specialties and institutions, supported by technological innovation grounded in rigorous training in both basic science and clinical practice. Only in this way it will be possible to shift from “just doing veins” to the best clinical vein-lymphatic practice for the Patient Health.
