Great Saphenous Vein Diameter at the Saphenofemoral Junction and Proximal Thigh as Parameters of Venous Disease Class

Objective To describe the mid-term outcome after inferior selective crossectomy in a subset of patients with symptomatic chronic venous disease and both great saphenous vein and suprasaphenic valve incompetence. Methodsː Retrospective analysis of prospectively collected data was conducted. During an eight-year period, 1095 ligations of all saphenofemoral junction inferior tributaries and great saphenous vein stripping were performed in 814 Clinical, Etiology, Anatomy, Pathophysiology C2–C6 patients. Duplex ultrasound follow-up examinations were performed after 30 days, 6 months, and 2 years, and saphenofemoral junction hemodynamic patterns and varicose veins recurrence rates were evaluated. Results Two hundred and twenty patients completed the two-year follow-up period. At the 30-day Duplex ultrasound evaluations, two different hemodynamic patterns were described. Type 1, with physiological drainage of saphenofemoral junction superior tributaries, was observed in 214 patients. Type 2, without flow in saphenofemoral junction superior tributaries, was observed in six patients. Overall varicose vein recurrence rates were 0, 2.3, and 2.7% at the 30-day, 6-month, and 2-year follow-up examinations, respectively. At the two-year follow-up, Type 1 patients showed 0% varicose vein recurrence, while Type 2 patients showed 100%. Conclusionsː Inferior selective crossectomy seems to be a valid and safe option in case of both suprasaphenic valve and great saphenous vein incompetence. Duplex ultrasound evaluation, according to our protocol, allows us to identify two different saphenofemoral junction hemodynamic patterns that could predict varicose vein recurrence at mid-term. An optimal stump washing after inferior selective crossectomy, warranted by patency and large caliber saphenofemoral junction superior tributaries, seems to be the key point in preventing varicose vein recurrence in this context. However, large prospective studies regarding saphenofemoral junction modifications and varicose vein recurrence are needed to confirm these preliminary observations.

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Endovenous heat-induced thrombosis after ablation with 1470 nm laser: Incidence, progression, and risk factors

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514526588 ◽

2014 ◽

Vol 30 (5) ◽

pp. 325-330 ◽

Cited By ~ 23

Author(s):

S Sufian ◽

A Arnez ◽

N Labropoulos ◽

S Lakhanpal

Keyword(s):

Risk Factors ◽

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Clinical Severity ◽

Endovenous Laser Ablation ◽

Severity Scores ◽

Class 1 ◽

Vein Diameter ◽

Saphenofemoral Junction

Objectives To evaluate the incidence of heat-induced thrombosis, its progression and risk factors that may contribute to its formation after endovenous laser ablation. Methods This was a prospective evaluation of all patients who had endovenous laser ablation of the great saphenous vein, accessory saphenous vein, and small saphenous vein using 1470 nm wavelength laser, from March 2010 to September 2011. All patients who developed endovenous heat-induced thrombosis at the saphenofemoral junction or at the saphenopopliteal junction were included. Demographic data, history of venous thrombosis, body mass index, vein diameter, reflux time, catheter tip position, endovenous heat-induced thrombosis progression, number of phlebectomies, and venous clinical severity scores were analyzed. Duplex ultrasound was done in all patients preoperatively, and 2–3 days postoperatively. Results Endovenous laser ablation was performed in 2168 limbs. Fifty-seven percent had great saphenous vein, 13% accessory saphenous vein, and 30% small saphenous vein ablation. Endovenous heat-induced thrombosis was developed in 18 limbs (12 at saphenofemoral junction and six at saphenopopliteal junction) for an incidence of 0.9%. Eight were class 1 and 10 were > class 2. No pulmonary embolism was reported. The percentage of men with endovenous heat-induced thrombosis was higher compared to those without (39% vs. 24%, p = .14). The median age for endovenous heat-induced thrombosis patients was 59.6 compared to non-endovenous heat-induced thrombosis ( p = .021). Great saphenous vein/accessory saphenous vein diameter for endovenous heat-induced thrombosis patients was 8.0 mm versus 6.3 mm for non-endovenous heat-induced thrombosis patients ( p = .014), and for small saphenous vein it was 5.7 mm versus 4.5 mm ( p = .16). Multiple concomitant phlebectomies were performed in 55.6% of the endovenous heat-induced thrombosis patients compared to 37% in non-endovenous heat-induced thrombosis ( p = .001). All other parameters were similar between endovenous heat-induced thrombosis and non-endovenous heat-induced thrombosis group. Endovenous heat-induced thrombosis resolution occurred in 16 cases at 2–4 but two cases progressing from class 1 to 2, before resolution. The mean VCSS score for endovenous heat-induced thrombosis patients preoperatively was 5.6 and improved to 2.8 ( p = .003) at one month. Conclusion Risk factors associated with endovenous heat-induced thrombosis formation after endovenous laser ablation include: vein size, age, and multiple phlebectomies. Endovenous heat-induced thrombosis resolves in 2–4 weeks in most patients but it may worsen in few.

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Venous Function after Restoring Valve Competence of the Great Saphenous Vein

Journal of Endovascular Therapy ◽

10.1177/152660280301000228 ◽

2003 ◽

Vol 10 (2) ◽

pp. 350-355 ◽

Cited By ~ 3

Author(s):

Gudmundur Danielsson ◽

Christel Jungbeck ◽

Karin Peterson ◽

Lars Norgren

Keyword(s):

Saphenous Vein ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Prospective Clinical Study ◽

Entry Site ◽

Vein Diameter ◽

Venous Function ◽

Saphenofemoral Junction ◽

Vein Reflux

Purpose: To measure changes in venous function after elimination of great saphenous vein reflux using endovenously-applied heat with a specially designed catheter. Methods: In a prospective clinical study, 13 patients (8 women; mean age 39 years, range 25–59) with symptomatic chronic venous insufficiency were treated for reflux at the saphenofemoral junction. A radiofrequency catheter (Restore) with expandable electrodes that shrinks the vein by controlled constriction of subendothelial collagen was used to restore valve competence. Extirpation of local varicosities was performed simultaneously. Main outcome was change in venous function as measured by plethysmography (foot volumetry) and change in diameter and reflux time at the saphenofemoral junction after 6 and 12 months. Results: Reflux in the greater saphenous vein was eliminated or reduced to below 0.5 seconds in all patients. The venous function was significantly improved after 6 months' follow-up, with decreased refilling rate/expelled volume related to foot volume (p=0.019). The patients were clinically improved, although only 7 (54%) were entirely free from reflux. Three (21%) patients had thrombus in the vein the day after the treatment, 2 at the treatment site and 1 at the entry site of the introducer. After 1 year, the patients are still satisfied with the results, although venous function is no longer significantly improved compared to baseline. Conclusions: It is possible to safely restore valvular competence by means of internally shrinking the vein diameter. The venous function is improved, although the vein has a tendency to increase in width with time; limited reflux reappears, with deterioration of venous function.

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A study to evaluate patterns of superficial venous reflux in patients with primary chronic venous disease

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514536384 ◽

2014 ◽

Vol 30 (7) ◽

pp. 455-461 ◽

Cited By ~ 7

Author(s):

Mahim I Qureshi ◽

Manj Gohel ◽

Louise Wing ◽

Andrew MacDonald ◽

Chung S Lim ◽

...

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Chronic Venous Disease ◽

Duplex Ultrasonography ◽

Venous Disease ◽

Venous Reflux ◽

History Of ◽

Primary Chronic Venous Disease ◽

Saphenofemoral Junction ◽

Vein Reflux

Objective This study assessed patterns of superficial reflux in patients with primary chronic venous disease. Methods Retrospective review of all patient venous duplex ultrasonography reports at one institution between 2000 and 2009. Legs with secondary, deep or no superficial reflux were excluded. Results In total, 8654 limbs were scanned; 2559 legs from 2053 patients (mean age 52.3 years) were included for analysis. Great saphenous vein reflux predominated (68%), followed by combined great saphenous vein/small saphenous vein reflux (20%) and small saphenous vein reflux (7%). The majority of legs with competent saphenofemoral junction had below-knee great saphenous vein reflux (53%); incompetent saphenofemoral junction was associated with combined above and below-knee great saphenous vein reflux (72%). Isolated small saphenous vein reflux was associated with saphenopopliteal junction incompetence (61%), although the majority of all small saphenous vein reflux limbs had a competent saphenopopliteal junction (57%). Conclusion Superficial venous reflux does not necessarily originate from a saphenous junction. Large prospective studies with interval duplex ultrasonography are required to unravel the natural history of primary chronic venous disease.

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More great saphenous vein valves - less varicose veins?

VASA ◽

10.1024/0301-1526/a000361 ◽

2014 ◽

Vol 43 (4) ◽

pp. 260-265 ◽

Cited By ~ 2

Author(s):

Anna-Barbara Gräub ◽

Markus Naef ◽

Hans E. Wagner ◽

Wolfgang G. Mouton

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Valve Disease ◽

Venous Disease ◽

Consecutive Series ◽

Macroscopic Appearance ◽

Disease Class ◽

Venous Valves ◽

Ceap Classification

Background: In patients with chronic venous disease (CVD) the number of venous valves and the degree of valve deterioration have not been extensively investigated and are poorly understood. The aim of this prospective study was to quantitatively and qualitatively investigate the venous valves in CVD patients in view of their clinical classification. Patients and methods: Within two years a consecutive series of 152 patients (223 limbs) undergoing primary surgery for great saphenous vein varicose veins was investigated. In all patients the C class according to the basic CEAP-classification was registered preoperatively (C2 to C6) for each limb. Both the quantity and quality of venous valves were assessed in the GSVs after removal. Qualitative evaluation of the valves was based on macroscopic appearance using a classification from 0 to 5 and described as valve disease class. Results: A negative correlation between age and the number of valves was detected (p = 0.0035). There was an increase of C-class with increasing age. No significant correlation between the average number of valves per meter and the C-class was detected. For all C-classes an average of between four and five valves per meter was counted. Valve disease class was positively correlated with the C-class although the valve disease class was never higher than the C-class (p < 0.05). Conclusions: The valve disease class of the great saphenous vein correlates with the C-class of the CEAP-classification. The number of valves did not correlate with the C-class. With each increase in the CEAP class the age increased as well.

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CHIVA with endoluminal procedu res: Laser versus VNUS

Phlebologie ◽

10.12687/phleb2346-1-2017 ◽

2017 ◽

Vol 46 (01) ◽

pp. 5-12 ◽

Cited By ~ 8

Author(s):

F. Amsler ◽

E. Mendoza

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Femoral Vein ◽

Surgical Techniques ◽

Light Reflection ◽

Common Femoral Vein ◽

General Data ◽

The Common ◽

Proximal Thigh ◽

Saphenofemoral Junction

SummaryIntroduction: Since it’s description the CHIVA strategy was performed with surgical techniques. After the introduction of endoluminal heat techniques these might be applied also in the CHIVA context.Method: 104 patients were investigated before and 3–6 months after the treatment of the great saphenous vein (GSV) with CHIVA strategy using enoluminal heat techniques to close the groin segment (VNUS Closure-Fast™ or LASER [1470 nm, Intros radial]). General data (age, sex, BMI) and phlebological data (QoL as reflected in VCSS, clinics as C[CEAP], refilling time after muscle pump measured with light reflection rheography, diameters of GSV at the groin and proximal thigh, as well as diameters of the common femoral vein) were measured and compared.Results: Significant reduction of diameters of GSV at proximal thigh from 6.5 ± 1.6 to 3.7 ± 1.1 and VFC from 15.2 ± 2.3 to 14.8 ± 2.2 were recorded, as well as reduction of clinical scores (VCSS from 5.6 ± 3.1 to 2.2 ± 2 and C[CEAP] from 3.2 ± 1 to 2.1 ± 1.1). Refilling time improved from 20.3 ± 11 to 28.8 ± 10.2. Results are comparable to those achieved after surgical crossectomy and published in other series.Conclusion: The disconnection of the insufficiency point at the saphenofemoral junction seems to be possible in the context of CHIVA Strategy applying endoluminal heat technique. No difference could be found between both techniques, Laser or VNUS Closure-Fast™.

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Correlation Between the Immediate Remnant Stump Length and Vein Diameter After Cyanoacrylate Closure Using the VenaSeal System During Treatment of an Incompetent Great Saphenous Vein

Vascular and Endovascular Surgery ◽

10.1177/1538574419879563 ◽

2019 ◽

Vol 54 (1) ◽

pp. 47-50 ◽

Cited By ~ 3

Author(s):

Insoo Park ◽

Daehwan Kim

Keyword(s):

Supine Position ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Cyanoacrylate Glue ◽

Factors Affecting ◽

Vein Diameter ◽

Proportional Relationship ◽

The Mean ◽

Extension Length ◽

Saphenofemoral Junction

Objectives: Cyanoacrylate glue is injected for incompetent great saphenous vein (GSV) treatment 5 cm distal to the saphenofemoral junction (SFJ). Although a few reports have investigated the postprocedural remnant stump length, none have focused on the factors affecting glue extension length and the consequent remnant stump length. Methods: Seventy-nine patients undergoing cyanoacrylate closure using the VenaSeal system at our clinic between August 2018 and November 2018 were investigated. The GSV diameter was measured just before treatment in the supine position 3 cm distal to the SFJ. Cyanoacrylate glue was injected 5 cm distal to the SFJ. Results: The mean glue extension length was 1.13 ± 1.12 cm. The GSV diameter and glue extension length exhibited a significant inversely proportional relationship ( P < .001). More specifically, patients with a GSV diameter ≥0.7 cm had a longer remnant stump length than those with a smaller GSV diameter ( P < .001). Conclusions: An increased GSV diameter is likely associated with a decreased glue extension length and, consequently, a longer remnant stump.

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