Commentary: No-Touch Saphenous Vein: Adding More Fuel to the Flame?

Author(s):  
Kenza Rahmouni ◽  
Fraser D. Rubens
Keyword(s):  
2007 ◽  
Vol 177 (4S) ◽  
pp. 509-509
Author(s):  
J. Christopher Webster ◽  
Alejandro J. Miranda-Sousa ◽  
Hugo H. Davila ◽  
Jorge L. Lockhart ◽  
Rafael E. Carrion
Keyword(s):  

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 120-124 ◽  
Author(s):  
Asciutto ◽  
Lindblad

Background: The aim of this study is to report the short-term results of catheter-directed foam sclerotherapy (CDFS) in the treatment of axial saphenous vein incompetence. Patients and methods: Data of all patients undergoing CDFS for symptomatic primary incompetence of the great or small saphenous vein were prospectively collected. Treatment results in terms of occlusion rate and patients’ grade of satisfaction were analysed. All successfully treated patients underwent clinical and duplex follow-up examinations one year postoperatively. Results: Between September 2006 and September 2010, 357 limbs (337 patients) were treated with CDFS at our institution. Based on the CEAP classification, 64 were allocated to clinical class C3 , 128 to class C4, 102 to class C5 and 63 to class C6. Of the 188 patients who completed the one year follow up examination, 67 % had a complete and 14 % a near complete obliteration of the treated vessel. An ulcer-healing rate of 54 % was detected. 92 % of the patients were satisfied with the results of treatment. We registered six cases of thrombophlebitis and two cases of venous thromboembolism, all requiring treatment. Conclusions: The short-term results of CDFS in patients with axial vein incompetence are acceptable in terms of occlusion and complications rates.


VASA ◽  
2006 ◽  
Vol 35 (3) ◽  
pp. 157-166 ◽  
Author(s):  
Hach-Wunderle ◽  
Hach

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.


Phlebologie ◽  
2008 ◽  
Vol 37 (06) ◽  
pp. 297-300
Author(s):  
N. König ◽  
H. J. Stark ◽  
P.-M. Baier

SummaryWe present two case reports concerning patients who had to undergone surgical treatment according tp the diagnosis of thrombophlebitis with insufficiency of the greater saphenous vein and putative encapsulated haematoma in the lower left leg area. During the operation we found tumours with urgent suspicion of malignancy. The histological examination revealed the diagnosis of mesenchymal chondrosarcoma and malignant peripheral nerve sheath tumour which are extremely malignant, but very rare neoplasmas with unfavourable prognosis. Conclusion: Since both types of tumours are often located below the knee, phlebotomists and vascular surgeons should take them into account as differential diagnosis.


Phlebologie ◽  
2010 ◽  
Vol 39 (02) ◽  
pp. 77-81 ◽  
Author(s):  
A. G. Krasznai ◽  
E. C. M. Bollen ◽  
J. C. van der Kley ◽  
R. J. Th. J. Welten ◽  
G. M. J. M. Welten

SummaryOur aim is to describe the results of a new short stripping technique for the treatment of the incompetent great saphenous vein (GSV) using a new developed surgical device. Patients, methods: 397 patients (498 legs) were treated with the InvisiGrip® Vein Stripper, which removes the GSV through a single groin incision, endovascular cutting and antegrade stripping by inversion. We reported the surgical success rate and postprocedural complications. Results: The mean age was 51 years, 74% were women. The success rate for removal of the GSV was 95%. The 23 failures were half patient related, half device related. In 82% of the strippings, one or two attempts were needed to successfully remove the GSV, which was done by invagination in 80%. Age, gender, BMI ≥30 kg/m2 and male GSV diameter were not associated with the number of attempts. Superficial wound infection, haematoma and temporary saphenous and femoral nerve injury occurred in 6 (1.6%), 0, 3 (0.8%) and 7 (1.9%) patients, respectively. Conclusion: The InvisiGrip® is highly successful for the removal of the GSV using short inverting stripping. Furthermore, it is simple, safe, associated with good cosmetic results and no preoperative selection of patients is necessary.


Phlebologie ◽  
2007 ◽  
Vol 36 (06) ◽  
pp. 309-312 ◽  
Author(s):  
T. Schulz ◽  
M. Jünger ◽  
M. Hahn

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.


1968 ◽  
Vol 20 (01/02) ◽  
pp. 247-256 ◽  
Author(s):  
M Pandolfi ◽  
B Robertson ◽  
S Isacson ◽  
Inga Marie Nilsson

SummaryA modification of the fibrin slide method of Todd permitting a semiquantitative estimation of the fibrinolytic activity in tissue sections is described. By means of this technique, the authors have studied the fibrinolytic activity of the great saphenous vein and of superficial veins of the arm and leg in patients suffering from varices and in normal subjects. It was found that:1. Fibrinolytic activity is localized, in these vessels, mainly to the vasa vasorum of the adventitia. The media is moderately active. Intimal cells are active only when detached.2. The great saphenous vein is more active above than below the knee.3. The veins of the arm are definitely more active than the veins of the leg.4. The activator of plasminogen demonstrated in the sections by the fibrin slide method is a fairly stable enzyme still active after exposure to 60° C and resistent to moderate variations of pH.


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