Outcomes of fluoroscopy-guided percutaneous high ligation of the great saphenous vein combined with foam sclerotherapy for symptomatic great saphenous veins

Objective Ultrasound-guided foam sclerotherapy (UGFS) – one of the most frequently recommended methods for treating great saphenous vein incompetence – is easy and inexpensive. However, it achieves a lower occlusion rate compared to endovenous thermal ablation. The application of UGFS to pre-terminal great saphenous vein interruption, eliminating the saphenous stem wash out effect, enhances the short-term occlusion rate. This study explores the results of this technique at 12 months. Method Thirty great saphenous veins (28 patients) with junction incompetence, with calibres >6 mm and >30 cm reflux stem length were submitted to echo-guided pre-terminal great saphenous vein interruption and foam great saphenous vein occlusion. Participants were subjected to a 12-month post-operative review by ultrasound assessment of great saphenous vein occlusion and terminal stump stability. Comparisons were made between pre-operative and 12-month Validation of Venous Clinical Severity Score (VCSS), photopletismography, Aberdeen questionnaire and complications. Results After 12 months, 28/30 great saphenous veins remained occluded (93%). One complete and one partial recanalization did not require retreatment. Four saphenous stumps showed a reflux during Valsalva (one due to recanalization, one limited to the stump, two with reflux in the anterior accessory saphenous vein). VCSS improved from 3.33 ± 1.64 to 0.67 ± 1.21 ( p < 0.05). Aberdeen questionnaire scores decreased from 9.44 ± 6.18 to 2.47 ± 3.77 ( p < 0.05). For photopletismographic examination, the mean venous refilling time (normal value: > 25 s) improved from 17.94 ± 11.97 to 31.4 ± 11.99 ( p < 0.05). Conclusion Applying pre-terminal great saphenous vein interruption to UGFS of the saphenous stem achieved an occlusion rate at one year similar to that of endovenous thermal ablation. The procedure is simple, effective, office based, and may be used as a 10-min prolongation to a phlebectomy.

Download Full-text

The sapheno femoral junction involvement in the treatment of varicose veins disease

Veins and Lymphatics ◽

10.4081/vl.2017.6822 ◽

2017 ◽

Vol 6 (2) ◽

Cited By ~ 2

Author(s):

Stefano Ricci

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

High Ligation ◽

Foam Sclerotherapy ◽

Endovenous Laser Ablation ◽

History Of ◽

New Generation ◽

Effect Of Hydrostatic Pressure ◽

The Ideal

Sapheno femoral junction (SFJ) incompetence has been considered the most important cause of chronic venous insufficiency in a high percent of cases since the beginning of history varicose veins treatment. As a consequence SFJ dissection, ligation and section has been practiced all along the last century, generally associated to great saphenous vein stripping, with the porpoise of stopping the effect of hydrostatic pressure considered the origin of varicose veins. Recurrence prevalence at the site of SFJ, even in correctly performed dissection suggests that this attitude may not be the ideal one. Moreover, with the introduction of catheter-based systems of endovenous heating of the great saphenous vein with radiofrequency or endovenous laser ablation, it was shown that venous ablation could be achieved without high ligation of the SFJ. Also foam sclerotherapy demonstrated good results, even if less effective, always leaving the SFJ untouched. Following this trend several methods have been suggested that spare the SFJ, so that this site have lost its strategical importance. In this review history of the SFJ involvement in the varicose vein strategy is analyzed with particular attention to the new generation methods, technology assisted, launched on the market.

Download Full-text

Prospective Randomized Study of Ultrasound-Guided Foam Sclerotherapy Combined with Great Saphenous Vein High Ligation in the Treatment of Severe Lower Extremity Varicosis

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2017.03.007 ◽

2017 ◽

Vol 5 (3) ◽

pp. 471-472

Author(s):

H. Yin ◽

H. He ◽

M. Wang ◽

Z. Li ◽

Z. Hu ◽

...

Keyword(s):

Lower Extremity ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Randomized Study ◽

Prospective Randomized Study ◽

High Ligation ◽

Ultrasound Guided ◽

Foam Sclerotherapy

Download Full-text

Invasive therapeutic options in truncal varicosity of the great saphenous vein

VASA ◽

10.1024/0301-1526.35.3.157 ◽

2006 ◽

Vol 35 (3) ◽

pp. 157-166 ◽

Cited By ~ 7

Author(s):

Hach-Wunderle ◽

Hach

Keyword(s):

Minimally Invasive ◽

Saphenous Vein ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Venous Pressure ◽

Stage Iii ◽

High Ligation ◽

Surgical Trauma ◽

Disease Stages

It is known from current pathophysiology that disease stages I and II of truncal varicosity of the great saphenous vein do not cause changes in venous pressure on dynamic phlebodynamometry. This is possibly also the case for mild cases of the disease in stage III. In pronounced cases of stage III and all cases of stage IV, however, venous hypertension occurs which triggers the symptoms of secondary deep venous insufficiency and all the complications of chronic venous insufficiency. From these facts the therapeutic consequence is inferred that in stages I and II and perhaps also in very mild cases of stage III disease, it is enough "merely" to remove varicose veins without expecting there to be any other serious complications in the patient’s further life caused by the varicosity. Recurrence rates are not included in this analysis. In marked cases of disease stages III and IV of the great saphenous vein, however, secondary deep venous insufficiency is to be expected sooner or later. The classical operation with saphenofemoral high ligation ("crossectomy") and stripping strictly adheres to the recognized pathophysiologic principles. It also takes into account in the greatest detail aspects of minimally invasive surgery and esthetics. In the past few years, developments have been advanced to further minimize surgical trauma and to replace the stripping maneuver using occlusion of the trunk vein which is left in place. Obliteration of the vessel is subsequently performed via transmission of energy through an inserted catheter. This includes the techniques of radiofrequency ablation and endovenous laser treatment. High ligation is not performed as a matter of principle. In a similar way, sclerotherapy using microfoam is minimally invasive in character. All these procedures may be indicated for disease stages I and II, and with reservations also in mild forms of stage III disease. Perhaps high ligation previously constituted overtreatment in some cases. Targeted studies are still needed to prove whether secondary deep venous insufficiency can be avoided in advanced stages of varicose vein disease without high ligation and thus without exclusion of the whole recirculation circuit.

Download Full-text

Sonographically guided, transcatheter foam sclerotherapy of the great saphenous vein

Phlebologie ◽

10.1055/s-0037-1622198 ◽

2007 ◽

Vol 36 (06) ◽

pp. 309-312 ◽

Cited By ~ 11

Author(s):

T. Schulz ◽

M. Jünger ◽

M. Hahn

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Clinical Stage ◽

Clinical Signs ◽

Cost Effective ◽

Duplex Sonography ◽

Foam Sclerotherapy ◽

Average Loss ◽

One Year ◽

The Cost

Summary Objective: The goal of the study was to assess the effectiveness and patient tolerability of single-session, sonographically guided, transcatheter foam sclerotherapy and to evaluate its economic impact. Patients, methods: We treated 20 patients with a total of 22 varicoses of the great saphenous vein (GSV) in Hach stage III-IV, clinical stage C2-C5 and a mean GSV diameter of 9 mm (range: 7 to 13 mm). We used 10 ml 3% Aethoxysklerol®. Additional varicoses of the auxiliary veins of the GSV were sclerosed immediately afterwards. Results: The occlusion rate in the treated GSVs was 100% one week after therapy as demonstrated with duplex sonography. The cost of the procedure was 207.91 E including follow-up visit, with an average loss of working time of 0.6 days. After one year one patient showed clinical signs of recurrent varicosis in the GSV; duplex sonography showed reflux in the region of the saphenofemoral junction in a total of seven patients (32% of the treated GSVs). Conclusion: Transcatheter foam sclerotherapy of the GSV is a cost-effective, safe method of treating varicoses of GSV and broadens the spectrum of therapeutic options. Relapses can be re-treated inexpensively with sclerotherapy.

Download Full-text

Discriminating Reflux from Non-Reflux Diseases of Superficial Veins in Legs by Novel Non-Contrast MR with QFlow Technique

Journal of Personalized Medicine ◽

10.3390/jpm11040242 ◽

2021 ◽

Vol 11 (4) ◽

pp. 242

Author(s):

Yuan-Hsi Tseng ◽

Chien-Wei Chen ◽

Min Yi Wong ◽

Teng-Yao Yang ◽

Bor-Shyh Lin ◽

...

Keyword(s):

Stroke Volume ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Flow Volume ◽

Mean Velocity ◽

Forward Flow ◽

Saphenous Veins ◽

Venous Diseases ◽

The Status ◽

Stroke Distance

Objectives: To find an objective diagnostic tool for the superficial veins in legs. Methods: This study included 137 patients who underwent TRANCE-MRI from 2017 to 2020 (IRB: 202001570B0). Among them, 53 with unilateral leg venous diseases underwent a QFlow scan and were classified into the reflux and non-reflux groups according to the status of the great saphenous veins. Results: The QFlow, namely stroke volume (SV), forward flow volume (FFV), mean flux (MF), stroke distance (SD), and mean velocity (MV) measured in the external iliac, femoral, popliteal, and great saphenous vein (GSV). The SV, FFV, SD, MF, SD, and MV in the GSV (morbid/non-morbid limbs) demonstrated a favorable ability to discriminate reflux from non-reflux in the ROC curve. The SD in the GSV and GSV/PV ratio (p = 0.049 and 0.047/cutoff = 86 and 117.1) and the MV in the EIV/FV ratio, GSV, and GSV/PV ratio (p = 0.035, 0.034, and 0.025/cutoff = 100.9, 86.1, and 122.9) exhibited the ability to discriminate between reflux and non-reflux group. The SD, MV, and FFV have better ability to discriminate a reflux from non-reflux group than the SV and MF. Conclusions: QFlow may be used to verify the reflux of superficial veins in the legs. An increasing GSV/PV ratio is a hallmark of reflux of superficial veins in the legs.

Download Full-text