Response to letter to editor regarding: “Great saphenous vein sparing techniques in lower extremity venous insufficiency treatment”

AbstractLower extremity venous insufficiency and varicose veins are common conditions, affecting up to 25% of women. Herein, we review the pathophysiology of lower extremity venous insufficiency and varicose veins, the epidemiology of varicose veins, clinical diagnosis, and ultrasonographic diagnosis. We also discuss treatment rationale, algorithms, and techniques, with a focus on endovenous great saphenous vein ablation.

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A potential therapeutic pitfall in the treatment of venous reflux due to variant planar anatomy of varicose segments

Phlebology The Journal of Venous Disease ◽

10.1177/0268355517722703 ◽

2017 ◽

Vol 33 (7) ◽

pp. 470-474

Author(s):

Sinan Deniz ◽

Derya Tureli ◽

Burcu Akpinar ◽

Levent Oguzkurt

Keyword(s):

Lower Extremity ◽

Clinical Outcomes ◽

Saphenous Vein ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Venous Reflux ◽

Planning Stage ◽

Vein Insufficiency ◽

Extremity Veins ◽

Variation Part

Purpose To elaborate on a planar anatomic variant of great saphenous vein as a potential therapeutic pitfall in the treatment of venous reflux. Materials and methods Lower extremity veins in 568 limbs with great saphenous vein insufficiency were sonographically mapped. A rather overlooked variation, the saphenous bow, was studied with emphasis on anatomic clarification and its involvement in venous insufficiency. Results This variation, observed in 5.1% (n = 29) of limbs, comprised two segments; one uninterrupted great saphenous vein proper coursing throughout saphenous compartment and one extra-compartmental segment originating distally from and proximally fusing with it. Venous arch remains within compartment only briefly during take-off and re-entry. Extra-compartmental venous arch had reflux either alone (10.3%) or together with intra-compartmental segment (75.9%). Conclusion This variation, part of saphenous segmental aplasia/hypoplasia complex, is associated with venous insufficiency. Meticulous mapping of great saphenous vein territory and identification of such variants during planning stage is indispensable for optimal clinical outcomes of treatment.

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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.

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Experienced Operators Achieve Superior Primary Patency and Wound Complication Rates With Endoscopic Great Saphenous Vein Harvest Compared With Open Harvest in Lower Extremity Bypasses

Journal of Vascular Surgery ◽

10.1016/j.jvs.2018.06.096 ◽

2018 ◽

Vol 68 (3) ◽

pp. e42-e43

Author(s):

Matthew Kronick ◽

Enjae Jung ◽

Cherrie Abraham ◽

Timothy Liem ◽

Gregory Moneta ◽

...

Keyword(s):

Lower Extremity ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Wound Complication ◽

Primary Patency ◽

Complication Rates

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Outcomes of knee-groin great saphenous vein stripping in patients with chronic venous insufficiency

International Journal of Surgery Science ◽

10.33545/surgery.2019.v3.i3a.03 ◽

2019 ◽

Vol 3 (3) ◽

pp. 09-12

Author(s):

Dr. Ali Sapmaz ◽

Dr. Serhan Yilmaz ◽

Dr. Murat Özgür Kiliç ◽

Dr. Betül Keskinkılıç Yağiz ◽

Dr. Ahmet Serdar Karaca ◽

...

Keyword(s):

Saphenous Vein ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Great Saphenous Vein

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Non-invasive pressure measurement of the great saphenous vein in healthy controls and patients with venous insufficiency

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-131737 ◽

2013 ◽

Vol 54 (3) ◽

pp. 325-332 ◽

Cited By ~ 2

Author(s):

M. Koster ◽

B.R. Amann-Vesti ◽

M. Husmann ◽

V. Jacomella ◽

T.O. Meier ◽

...

Keyword(s):

Saphenous Vein ◽

Pressure Measurement ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Healthy Controls ◽

Non Invasive

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Experienced operators achieve superior patency and wound complication rates with endoscopic great saphenous vein harvest compared with open harvest in lower extremity bypasses

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.02.043 ◽

2019 ◽

Vol 70 (5) ◽

pp. 1534-1542 ◽

Cited By ~ 1

Author(s):

Matthew Kronick ◽

Timothy K. Liem ◽

Enjae Jung ◽

Cherrie Z. Abraham ◽

Gregory L. Moneta ◽

...

Keyword(s):

Lower Extremity ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Wound Complication ◽

Complication Rates

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Endovenous cyanoacrylate glue to treat varicose veins and chronic venous insufficiency—Experience gained from our first 100+ truncal venous ablations in a multi-ethnic Asian population using the Medtronic VenaSeal™ Closure System

Phlebology The Journal of Venous Disease ◽

10.1177/0268355519826008 ◽

2019 ◽

Vol 34 (8) ◽

pp. 543-551 ◽

Cited By ~ 8

Author(s):

Tjun Y Tang ◽

Harsha P Rathnaweera ◽

Jia W Kam ◽

Tze T Chong ◽

Edward C Choke ◽

...

Keyword(s):

Saphenous Vein ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Asian Population ◽

Closure System ◽

Cyanoacrylate Glue ◽

Catheter Technique

Objectives The aim of this prospective single-centre study is to assess the effectiveness and patient experience of the VenaSeal™ Closure System, a novel non-thermal, non-tumescent catheter technique, which uses cyanoacrylate glue to occlude the refluxing truncal superficial veins to treat varicose veins and chronic venous insufficiency, in a multi-ethnic Asian population from Singapore. Methods Seventy-seven patients (93 legs; 103 procedures) underwent VenaSeal™ Closure System ablation. Forty-nine (63.6%) for great saphenous vein incompetence, 16 (20.8%) bilateral great saphenous vein, 2 (2.6%) small saphenous vein and 10 (13.0%) combined unilateral great saphenous vein and small saphenous vein/anterior thigh vein reflux. In addition, 65/93 legs (69.9%) had C4–C6 disease. Patients were reviewed at 2 weeks, 3, 6 and 12 months post-procedure. Results There was 100% technical success. 28/77 (36.4%) underwent concomitant phlebectomies. All procedures were well tolerated with a mean post-operative pain score of 3.0 (range: 0–5). After three months, median patient satisfaction was 9.0 (interquartile range: 7.0–10.0). At two-week follow-up, the great saphenous vein was completely occluded in 88/88 (100%) veins and small saphenous vein completely closed in 11/11 (100%) veins. At three-month follow-up, the great saphenous vein was occluded in 51/53 (96.2%) veins and small saphenous vein completely closed in 5/5 (100%) veins. At six-month follow-up, the great saphenous vein was completely occluded in 42/45 (93.3%) veins and small saphenous vein completely closed in 5/7 (71.4%) veins. At one year, great saphenous vein and small saphenous vein occlusion rates were 54/59 (91.5%) and 5/8 (62.5%), respectively. There was one deep vein thrombosis. Transient superficial phlebitis was reported in 10/93 (10.8%) legs, which were all self-limiting. There were 9/103 (8.7%) anatomical recurrences, but no patients required re-intervention as they were asymptomatic. Conclusions Cyanoacrylate glue is a safe and efficacious modality to ablate refluxing saphenous veins in Asian patients in the short term. There is a high satisfaction rate and peri-procedural pain is low. Early results are promising but further evaluation and longer term follow-up are required.

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