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

1996 ◽  
Vol 11 (2) ◽  
pp. 45-49 ◽  
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.

A Study of the Mechanisms by Which Haemodynamic Function Improves following Long Saphenous Vein-Saving Surgery

1996 ◽  
Vol 11 (3) ◽  
pp. 102-105 ◽  
Author(s):  
J. Hammarsten ◽  
P. Bernland ◽  
M. Campanello ◽  
M. Falkenberg ◽  
O. Henrikson ◽  
...  
Keyword(s):  
Physical Examination ◽  
Saphenous Vein ◽  
Strain Gauge ◽  
Venous Return ◽  
Varicose Veins ◽  
Return Time ◽  
Strain Gauge Plethysmography ◽  
Long Saphenous Vein ◽  
Primary Varicose Veins ◽  
Vein Diameter

Objective: To study the mechanisms by which haemodynamic function improves following long saphenous vein-saving surgery. Design: Cohort study. Patients: Twenty patients, 14 women and six men, with primary varicose veins. Interventions: Varicose vein surgery by the long saphenous vein-saving technique. Main outcome measures: Preoperative investigation by physical examination, strain-gauge plethysmography, phlebography and measurements of the long saphenous vein diameter at four different locations using high-resolution, real-time ultrasound. Three months following vein-saving surgery, the patients were reassessed with physical examination, strain-gauge plethysmography and measurements of the long saphenous vein diameter. Results: All patients but one showed excellent or good results following surgery. The preoperative diameter of the long saphenous vein was reduced by 40% at four different levels in the operated legs ( p<0.01). The venous return time of the same legs increased 2.4 times ( p<0.001). The decrease of the long saphenous vein diameter correlated positively with the increase in venous return time (t-50), ( r=0.50, p=0.04). Conclusion: The results suggest that the development of incompetent perforators is an early major event in the formation of primary varicose veins. The results also suggest that the long saphenous vein valvular incompetence in varicose veins is attributable to venous wall dilatation rather than degeneration of the valves. The results support the hypothesis that the improvement in haemodynamic function following long saphenous vein-saving surgery is due, at least partly, to a reduction of the long saphenous vein diameter, which in turn tends to restore valvular competence.

Failure of Angioscopically Guided Sclerotherapy to Permanently Obliterate Greater Saphenous Varicosity

1994 ◽  
Vol 9 (1) ◽  
pp. 21-24 ◽  
Author(s):  
K. Biegeleisen ◽  
R. D. Nielsen
Keyword(s):  
Outcome Measures ◽  
Saphenous Vein ◽  
Single Group ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Office Setting ◽  
Long Saphenous Vein ◽  
Saphenofemoral Junction

Objective: To assess the long-term outcome of sclerotherapy. Design: Single group study of patients with incompetence of the long saphenous vein. Setting: All treatments were performed in a private office setting. Patients: Sixteen patients with untreated varicosities limited to the greater saphenous vein, which was 10 mm in diameter at the saphenofemoral junction in all cases. Interventions: Angioscopically guided sclerosis of the long saphenous vein. Main outcome measures: Colour-flow ultrasound was used to establish the presence of residual reflux after angioscopic treatment. Results: Total obliteration of saphenofemoral reflux was obtained in 12 veins with angioscopic sclerotherapy. All veins on which follow-up was available (nine veins in seven patients) had undergone substantial recanalization by 12 months after treatment. Conclusion: Angioscopically controlled sclerotherapy effectively obliterates the saphenophemoral junction. Recanalization of the sclerosed segment of vein occurs invariably within 12 months of treatment.

High Tie with Sclerotherapy for Saphenous Vein Insufficiency

1986 ◽  
Vol 1 (2) ◽  
pp. 105-111 ◽  
Author(s):  
Peter Neglén ◽  
Eibert Einarsson ◽  
Bo Eklöf
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Volume Ratio ◽  
Long Term Results ◽  
Functional Evaluation ◽  
High Tie ◽  
Long Saphenous Vein ◽  
Primary Varicose Veins ◽  
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.

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

1996 ◽  
Vol 11 (3) ◽  
pp. 98-101 ◽  
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

scholarly journals Primary varicose veins: Frequency, clinical significance and surgical treatment

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.

scholarly journals ENDOVENOUS LAZER COAGULATION: LONG-TERM RESULT - CRITERION OF TRUTH

2018 ◽  
Vol 3 (4) ◽  
pp. 27-30
Author(s):  
A G Shalashov ◽  
A V Kazantsev
Keyword(s):  
Varicose Veins ◽  
Intraoperative Complications ◽  
Lower Limbs ◽  
Long Term Results ◽  
Laser Coagulation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Result ◽  
Varicose Disease

Objectives - to study the long-term results of endovenous laser coagulation in patients with varicose veins of the lower extremities. Material and methods. The study included 241 patients with varicose disease of the lower limbs veins, who underwent surgical treatment using the method of endovenous laser coagulation. Results. The technical success of the operation was achieved in all cases, which was confirmed by color duplex scanning. There were no intraoperative complications. Long-term outcome was studied in 174 (72.2%) patients in the period up to 5 years. During the follow-up period the GSV occlusion signs were detected in 168 (96.4%) patients, partial recanalization of the GSV was registered in 6 (3.5%) patients.

Venous Muscle Pump Improvement by Low Compression Elastic Stockings

1986 ◽  
Vol 1 (2) ◽  
pp. 97-103 ◽  
Author(s):  
Jan Struckmann ◽  
Søren Jesper Christensen ◽  
Axel Lendorf ◽  
Frits Mathiesen
Keyword(s):  
Venous Return ◽  
Varicose Veins ◽  
Return Time ◽  
Physiological Effect ◽  
Compression Stocking ◽  
Subjective Improvement ◽  
Muscle Pump ◽  
Before And After ◽  
Elastic Stockings ◽  
Primary Varicose Veins

The physiological effect of a graduated low compression stocking T.E.D.(R) (Kendall Co.) was evaluated by plethysmographic musculo-venous pump determination in 22 patients with primary varicose veins. A hip length T.E.D.(R) stocking was worn for a 6-week period. Efficiency of the musculo-venous pump was determined before and after treatment and a significant increase in venous return time (RT) and expelled volume (EV) was demonstrated. This was accompanied by subjective improvement. The pressure exerted by the stockings was measured in 20 legs by the Borgnis and Van den Berg method, and the pressure was in all cases below 15 mmHg. Effect of such low compression has not previously been documented for expelled volume in patients with varicose veins.

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