High Tie with Sclerotherapy for Saphenous Vein Insufficiency

The long-term results after treatment of primary varicose veins with a combination of compression sclerotherapy (CST) and high tie of the incompetent long saphenous vein were studied. Sixty-three legs in 60 patients were operated on. Subjective (by the patient), objective (by the surgeon) and functional (by foot volumetry) assessments were performed just after treatment, 6 months and 1, 3 and 5 years later. The immediate subjective results were excellent but objectively 21% of the patients still had residual varicosities. After 5 years 50% were subjectively well but only 16% of the legs were objectively cured. Among the foot volumetric parameters the expelled volume (EV; ml) and refilling flow/relative expelled volume ratio (Q/EVrel; min−1) best reflected the functional state. Mean EV increase was 56% after treatment but only 16% after 5 years. Q/EVrel normalized initially but deteriorated after 1 year. No significant improvement in any parameter was observed after 5 years. CST combined with high tie cannot replace surgery in patients with main stem insufficiency. The results emphasize the importance in following these patients for at least 5 years. On the whole, functional evaluation with foot volumetry was valuable to assess groups but could not replace the examination of individual patients.

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Standard Stripping versus Long Saphenous Vein-Saving Surgery for Primary Varicose Veins: A Prospective, Randomized Study with the Patients as Their Own Controls

Phlebology The Journal of Venous Disease ◽

10.1177/026835559601100202 ◽

1996 ◽

Vol 11 (2) ◽

pp. 45-49 ◽

Cited By ~ 28

Author(s):

M. Campanello ◽

J. Hammarsten ◽

C. Forsberg ◽

P. Bernland ◽

O. Henrikson ◽

...

Keyword(s):

Saphenous Vein ◽

Venous Return ◽

Varicose Veins ◽

Return Time ◽

Term Outcome ◽

Long Term Outcome ◽

Long Saphenous Vein ◽

Primary Varicose Veins ◽

Postoperative Discomfort

Objective: To compare the postoperative discomfort and long-term outcome following standard stripping and atter long saphenous vein-saving surgery. Design: Prospective, randomized case-control study with patients serving as their own controls. Setting: Department of Surgery, County Hospital, Varberg, Sweden. Patients: Eighteen patients with bilateral primary varicose veins. Interventions: The patients were randomized prospectively to stripping or long saphenous vein-saving surgery. The leg causing most discomfort was operated on first. The other leg was operated on using the alternative method. Main outcome measures: Postoperative discomfort was assessed after an interview with the patient. Long-term outcome was determined by clinical assessment and Plethysmographic venous return time. Results: After 4 years the legs subjected to long saphenous vein-saving surgery yielded equal clinical results and had as great a prolongation of the plethysmographic venous return time as legs operated on using standard stripping. More patients reported greater discomfort following stripping than after vein-saving surgery. The saved long saphenous vein in all legs operated on was patent, compressible, non-sclerotic and free of intraluminal echoes. Conclusion: The long-term results of long saphenous vein-saving surgery are as good as standard stripping, provided that incompetent perforators are throughly mapped preoperatively and ligated at surgery. Long saphenous vein-saving surgery causes less subjective postoperative discomfort than standard stripping. The saved long saphenous vein can probably be used for future arterial reconstruction.

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Radiofrequency ablation of the long saphenous vein without high ligation versus high ligation and stripping for primary varicose veins: Pros and cons

Seminars in Vascular Surgery ◽

10.1053/svas.2002.30448 ◽

2002 ◽

Vol 15 (1) ◽

pp. 34-38 ◽

Cited By ~ 1

Author(s):

E. John Harris

Keyword(s):

Radiofrequency Ablation ◽

Saphenous Vein ◽

Varicose Veins ◽

High Ligation ◽

Long Saphenous Vein ◽

Primary Varicose Veins ◽

Pros And Cons

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Radiofrequency ablation of the long saphenous vein without high ligation versus high ligation and stripping for primary varicose veins: Pros and cons

Seminars in Vascular Surgery ◽

10.1016/s0895-7967(02)70014-8 ◽

2002 ◽

Vol 15 (1) ◽

pp. 34-38 ◽

Cited By ~ 8

Author(s):

E. John Harris

Keyword(s):

Radiofrequency Ablation ◽

Saphenous Vein ◽

Varicose Veins ◽

High Ligation ◽

Long Saphenous Vein ◽

Primary Varicose Veins ◽

Pros And Cons

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Plication of the Sapheno–Femoral Junction: Effects on Incompetence after Two Years

Phlebology The Journal of Venous Disease ◽

10.1177/026835559100600303 ◽

1991 ◽

Vol 6 (3) ◽

pp. 159-165 ◽

Cited By ~ 3

Author(s):

Giovanni V. Belcaro

Keyword(s):

Coronary Artery ◽

Saphenous Vein ◽

Femoral Vein ◽

Venous Pressure ◽

Signs And Symptoms ◽

Long Term Results ◽

Pressure Measurements ◽

Venous Reflux ◽

Long Saphenous Vein

Plication of the long saphenous vein at the sapheno–femoral junction (SFJ) is an alternative to flush ligation and stripping. This technique abolishes reflux at the SFJ without altering the vein; this may then be used for arterial surgery or coronary artery grafting. Candidates for plication were selected on the basis of ambulatory venous pressure measurements and duplex scanning. These tests indicate and quantify the degree of superficial venous incompetence. Plication of the SFJ reduces the calibre of the vein to 60–70% for a length of 1.5 cm, allowing the value cusps to close when flow in the femoral vein is reversed. In this study 20 limbs were evaluated (in 20 patients) 6, 12 and 24 months after plication. Venous reflux was significantly reduced and there was an improvement in signs and symptoms. Thus, SFJ plication seems to be an effective physiological alternative to flush ligation in some subjects. However, long-term results (> 5 years) must be still evaluated.

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Haemodynamic Correction of Varicose Veins (CHIVA): An Effective Treatment?

Phlebology The Journal of Venous Disease ◽

10.1177/026835559601100305 ◽

1996 ◽

Vol 11 (3) ◽

pp. 98-101 ◽

Cited By ~ 4

Author(s):

P. Zamboni ◽

C.V. Feo ◽

M. G. Marcellino ◽

G. Vasquez ◽

C. Mari

Keyword(s):

Saphenous Vein ◽

Continuous Wave ◽

Varicose Veins ◽

Venous Pressure ◽

Vein Thrombosis ◽

Long Saphenous Vein ◽

Group A ◽

Primary Varicose Veins ◽

Short Saphenous Vein ◽

Group B

Objective: Evaluation of the feasibility and utility of haemodynamic correction of primary varicose veins (French acronym: CHIVA). Design: Prospective, single patient group study. Setting: Department of Surgery, University of Ferrara, Italy (teaching hospital). Patients: Fifty-five patients with primary varicose veins and a normal deep venous system (ultrasonographic criteria) were studied. Interventions: Fifty-five haemodynamic corrections by the CHIVA method described by Franceschi were undertaken. Seven patients were treated for short saphenous vein varices (group A) while 48 patients were treated for long saphenous vein varices (group B). Main outcome measures: Clinical: presence of varices and reduction in symptoms. Duplex and continuous-wave Doppler detection of re-entry through the perforators and identification of recurrences or new sites of reflux. Postoperative ambulatory venous pressure and refilling time measurements. Patients were studied for 3 years following surgery. Results: In group A, 57% short saphenous vein occlusions with no re-entry through the gastrocnemius and soleal veins were recorded. In group B the long saphenous vein thrombosis rate was 10%. In this group 15% of the patients showed persistence of reflux instead of re-entry at the perforators. Early recurrences were also observed. Overall CHIVA gave excellent results in 78% of the patients. Statistically significant ambulatory venous pressure and refilling time changes were recorded ( p<0.001). Conclusions: CHIVA treatment is inadvisable for short saphenous vein varices. Long saphenous vein postoperative thrombosis is related to development of recurrences

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Primary varicose veins: Frequency, clinical significance and surgical treatment

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0412398v ◽

2004 ◽

Vol 132 (11-12) ◽

pp. 398-403

Author(s):

Dragan Vasic ◽

Lazar Davidovic ◽

Zivan Maksimovic ◽

Aleksandra Crni ◽

Miroslav Markovic ◽

...

Keyword(s):

Surgical Treatment ◽

Saphenous Vein ◽

Varicose Veins ◽

World Health ◽

Superficial Thrombophlebitis ◽

Perforating Veins ◽

Long Saphenous Vein ◽

Significant Difference ◽

Primary Varicose Veins ◽

Short Saphenous Vein

INTRODUCTION According to the definition of the World Health Organization, varicose veins represent abnormally enlarged superficial veins having baggy or cylindrical shape. The most frequent cause of primary varicose veins is the insufficiency of long saphenous vein (LSV), but especially the basin of its connection with femoral vein and perforating veins. OBJECTIVE The objectives of these investigations were: the determination of insufficiency incidence of SSV in cases of LSV insufficiency; the establishment of association of insufficiency of perforating veins of the basin of LSV and SSV; the study of the results of surgical treatment of insufficiency and varicosity of both short and long saphenous veins. METHODS In this study, 100 patients (66 women and 34 men), average age 52.1 years, with clinical symptoms showing the insufficiency and varicosity of long saphenous vein with no change of deep vein system were examined. Ultrasonographic examinations were made using Color Doppler probes - 7.5 and 3.75 MHz (Toshiba Corevison SSA 350 A); the development of incompetence of long saphenous vein (LSV) and short saphenous vein (SSV) at the level of the junction as well as other incompetent valves were examined. The reflux was defined as a retrograde flow of the duration longer than 0.5 seconds. RESULTS The insufficiency of short saphenous vein was determined by ultrasonographic examination in 34%, while the insufficiency of perforating veins in 80% of patients. 40% of patients were operated (33.3% of females, and 52.9% of males). The most frequent indications for surgical treatment of superficial veins insufficiency were: strong varicosities, clear symptoms and signs, superficial thrombophlebitis and conditions after superficial thrombophlebitis. Surgical treatment was applied in 16% of patients due to recurrence in the basin of long saphenous vein, and in 6% of cases because of the recurrence in the basin of short saphenous vein. Data analysis failed to discover any statistically significant difference between the age of patients and varicosities in the basin of long saphenous vein as well as in the basin of short saphenous vein (51.98?9.97 years; 54.50?31.82 years; t=0.36; p>0.05), or any significant difference of BMI value, with regard to the obesity of patients and varicosities in the basin of long saphenous vein as well as in the basin of short saphenous vein (28.02?4.61 kg/m2; 24.50?6.36 kg/m2; t=0.50; p>0.05). No statistically significant correlation was found between Color Duplex findings of insufficiency of both long saphenous vein and short saphenous vein (p=-0.21 ; p>0.05), nor any significant correlation of Color Duplex findings of perforating veins insufficiency in the basin of long saphenous vein and short saphenous vein (p=-0.115; p>0.05). CONCLUSION The incidence of insufficiency is significant: approximately every third patient has short saphenous vein insufficiency, while three third of patients have perforating veins insufficiency. Color Duplex limb's veins ultrasonography is highly reliable method for the examination and study of superficial veins diseases, which is very important for preoperative decision-making and selection of surgical technique as well as for postoperative follow-up.

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