Subfascial endoscopic perforator surgery using a soft trocar for varicose veins in the lower leg

Objective: To describe the use of a novel soft trocar to perform subfascial endoscopic perforator surgery (SEPS) in patients with varicose veins in the lower leg. Procedures: From January 1999 through March 2001, SEPS was performed in 14 patients (17 legs) with primary varicose veins (clinical classes 3-6) by using a soft trocar. The soft trocar is a Y-shaped polyvinyl chloride bag with two ports at one end and a flexible, sealing ring at the opposite end. The subfascial space was dissected with an endoscopic dissection cannula and expanded with a balloon. Carbon dioxide gas insufflation was applied, and the perforating veins were divided by using UltraShears inserted simultaneously with an endoscope through the second port of the trocar. Results: A mean of 4.7 ± 2.9 perforating veins per leg were divided. No wound complications occurred. Conclusion: Use of the soft trocar facilitates both visualization and manipulation during SEPS.

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Strip-tract revascularization as a source of recurrent venous reflux following high saphenous tie and stripping: results at 5–8 years after surgery

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514535927 ◽

2014 ◽

Vol 30 (8) ◽

pp. 569-572 ◽

Cited By ~ 15

Author(s):

Alexandra E Ostler ◽

Judy M Holdstock ◽

Charmaine C Harrison ◽

Barrie A Price ◽

Mark S Whiteley

Keyword(s):

Response Rate ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Duplex Ultrasonography ◽

Venous Reflux ◽

Primary Varicose Veins ◽

And Inversion ◽

Saphenofemoral Junction ◽

Subfascial Endoscopic Perforator Surgery

Objective We have previously reported strip-tract revascularization 1 year following high saphenous ligation and inversion stripping. This study reports the 5–8 year results in the same cohort. Methods Between 2000 and 2003, 72 patients presented with primary varicose veins and had undergone high saphenous ligation and inversion stripping plus phlebectomies with or without subfascial endoscopic perforator surgery. Of the 64 patients who had attended for follow-up at 1 year, 35 patients (male:female, 16:19; 39 legs) underwent duplex ultrasonography 5–8 years after surgery (response rate 55%). Duplex ultrasonography was performed and all strip-tract revascularization and reflux and groin neovascularization was documented. Results Eighty-two percent of legs of patients showed some evidence of strip-tract revascularization and reflux. Full and partial strip-tract revascularization and reflux was seen in 12.8% and 59% of limbs of patients, respectively, and 10.2% limbs of patients had neovascularization only at the saphenofemoral junction only. Seven limbs of patients showed no revascularization. Conclusion Five to eight years after high saphenous tie and stripping, 82% of legs of patients showed some strip-tract revascularization and reflux and 12% showed total revascularization and reflux of the stripped great saphenous vein.

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Management of venous ulcers according to their anatomical relationship with varicose veins

Phlebology The Journal of Venous Disease ◽

10.1177/0268355516676124 ◽

2017 ◽

Vol 33 (1) ◽

pp. 44-52 ◽

Cited By ~ 1

Author(s):

Yun-Nan Lin ◽

Tung-Ying Hsieh ◽

Shu-Hung Huang ◽

Chia-Ming Liu ◽

Kao-Ping Chang ◽

...

Keyword(s):

Recurrence Rate ◽

Varicose Veins ◽

Venous Ulcer ◽

Perforating Veins ◽

Venous Ulcers ◽

Kaplan Meier ◽

High Satisfaction ◽

Anatomical Relationship ◽

Primary Varicose Veins ◽

Satisfaction Rates

Background Adequately excising varicose and incompetent perforating veins is necessary for reducing their recurrence rate of venous ulcer. Method In total, 66 venous ulcers (C6) in 1083 legs with primary varicose veins were managed through endoscopic-assisted surgery. In an endoscopic operative view, the nonvaricose, varicose, and incompetent perforating veins were clearly visualized and precisely dissected. The varicose and incompetent perforating veins were divided and completely excised. Result The varicose veins were traced to the base or periphery of the 55 ulcers. Moreover, 89.4% of the ulcers healed within 14 weeks. Kaplan–Meier analysis revealed a five-year recurrence rate of 0.0%, and the satisfaction mean score was 4.6. Conclusion Endoscopic-assisted surgery can be used to radically excise varicose veins complicated with venous ulcers; the surgery yields low recurrence and high satisfaction rates.

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Pre- and Postoperative Evaluation by Photoplethysmography in Patients Receiving Surgery for Lower-Limb Varicose Veins

International Journal of Vascular Medicine ◽

10.1155/2014/562782 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Orlando Adas Saliba Júnior ◽

Mariangela Giannini ◽

Ana Paula Mórbio ◽

Orlando Saliba ◽

Hamilton Almeida Rollo

Keyword(s):

Lower Limb ◽

Varicose Veins ◽

Lower Limbs ◽

Varicose Vein Surgery ◽

Postoperative Evaluation ◽

Perforating Veins ◽

Primary Varicose Veins ◽

Ceap Classification ◽

The Mean ◽

Deep Vein

Objective. To evaluate the effectiveness of surgery in treating primary varicose veins in the lower limbs by photoplethysmography (PPG) and duplex mapping (DM).Method. Forty-eight lower limbs were clinically evaluated according to the CEAP classification system and subjected to PPG and DM exams. Each limb had a venous refill time (VRT) of <20 seconds and a normal deep vein system (DVS) by DM.Results. The mean pre- and postoperative VRTs were 13.79 and 26.43 seconds, respectively (P<0.0001). After surgery, 42 limbs (87.50%) had normal results by PPG (VRT > 20 seconds). Four limbs (8.33%) showed improved VRTs, but the VRTs did not reach 20 seconds. In the 2 limbs (4.17%) that maintained their original VRTs, the DM exams showed the presence of insufficient perforating veins.Conclusion. In most cases, PPG allows for a satisfactory evaluation of the outcome of varicose vein surgery.

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Varicose vein appearance caused by perforating vein incompetence detected after intense cycling

SAGE Open Medical Case Reports ◽

10.1177/2050313x17747490 ◽

2017 ◽

Vol 5 ◽

pp. 2050313X1774749

Author(s):

Charlotte E Davies ◽

Angie M White ◽

Mark S Whiteley

Keyword(s):

General Population ◽

Varicose Vein ◽

Varicose Veins ◽

Lower Leg ◽

Venous Reflux ◽

Perforating Veins ◽

Competitive Cyclists ◽

Left Calf ◽

Perforating Vein

The role of incompetent perforating veins in the aetiology of varicose veins is not well understood. Anecdotally, competitive cyclists appeared to be more prone to varicose veins than the general population. We present a case of a 63-year-old amateur competitive cyclist who acutely developed a painful varicosity of her left calf while straining during a hill climb in 106-mile cycle race. Duplex ultrasonography has shown an underlying incompetent perforating vein, feeding the varicosity directly through the underlying muscle. With no other significant venous reflux in either leg, we believe this case shows a clear causative association between the stresses put across the lower leg during competitive cycling and developing a varicose vein via an incompetent perforating vein. We believe this should lead to further investigations as to any link between cycling, perforator vein incompetence and the development of varicose veins.

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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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Endoscope-assisted management of primary varicose veins of the long saphenous vein and its tributaries

Phlebology The Journal of Venous Disease ◽

10.1258/026835504773042257 ◽

2004 ◽

Vol 19 (1) ◽

pp. 35-41 ◽

Cited By ~ 2

Author(s):

S-D Lin ◽

Y-L Yang ◽

S-S Lee ◽

K-P Chang ◽

T-M Lin ◽

...

Keyword(s):

Saphenous Vein ◽

Varicose Veins ◽

Saphenous Nerve ◽

Perforating Veins ◽

Long Saphenous Vein ◽

Primary Varicose Veins ◽

The Mean ◽

Assisted Management ◽

Incision Wound

Objective: Primary varicose veins of the long saphenous vein and its tributaries were managed in 104 limbs of 101 patients with the assistance of endoscopic surgery. Methods: Patients were divided into four clinico-anatomical types according to normal veins involved in the varicosities. With good illumination and magnified monitor viewing by means of a surgical endoscope, the varicositic trunk, varicositic tributaries, incompetent perforating veins and healthy veins could be clearly visualized and identified. Through two or more access incisions (2.5-3.0 cm in length), the varicose veins were completely dissected, divided and removed. The incompetent perforating veins were clipped and divided. In all cases, the mean number of incisions in each limb was 3.0. Results: The most common cause of morbidity was maceration of the incision wound. Transient numbness may have presented at the dissected area, but there were no signs of injury to the saphenous nerve. Conclusions: There was very little possibility of recurrence, because no residual varicosities or incompetent perforating veins remained after this operation. Recurrence presented in only one case at follow up, three months postoperatively. Patients were satisfied with the minimal surgical scarring and complete absence of disfiguring varicosities in the limb.

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Endoscope-assisted management of primary varicose veins below the knee

Phlebology The Journal of Venous Disease ◽

10.1258/026835505774964892 ◽

2005 ◽

Vol 20 (4) ◽

pp. 163-169 ◽

Cited By ~ 1

Author(s):

S-D Lin ◽

T-M Lin ◽

S-S Lee ◽

Y-L Yang ◽

I-F Sun ◽

...

Keyword(s):

Endoscopic Surgery ◽

Varicose Veins ◽

Good Alternative ◽

Perforating Veins ◽

Long Saphenous Vein ◽

Below The Knee ◽

Primary Varicose Veins ◽

The Mean ◽

Assisted Management

Objective: Primary varicose veins below the knee were managed with the assistance of endoscopic surgery in 240 limbs (235 cases). Methods: Patients were classified into five clinico-anatomic types according to associated normal veins involved in the varicosities. All procedures were limited to below the knee. With the superior illumination and magnified monitor view offered by the endoscope, all the varicosities and the incompetent perforating veins were dissected, clipped, divided and removed through one or more access incisions (2.5–3.0 cm in length). However, the normal veins were preserved, including the long saphenous vein. Results: The mean number of incisions in each limb of all patients was 1.86. As there were no residual varicosities or incompetent perforating veins, there was little possibility of recurrence. In the follow-up of 218 limbs, recurrence occurred in only two limbs. Conclusion: Endoscope-assisted surgery is a good alternative for management of primary varicose veins below the knee, resulting in low recurrence and aesthetically acceptable surgical scarring.

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