CHIVA with endoluminal procedu res: Laser versus VNUS

Phlebologie ◽  
2017 ◽  
Vol 46 (01) ◽  
pp. 5-12 ◽  
Author(s):  
F. Amsler ◽  
E. Mendoza
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Femoral Vein ◽  
Surgical Techniques ◽  
Light Reflection ◽  
Common Femoral Vein ◽  
General Data ◽  
The Common ◽  
Proximal Thigh ◽  
Saphenofemoral Junction

SummaryIntroduction: Since it’s description the CHIVA strategy was performed with surgical techniques. After the introduction of endoluminal heat techniques these might be applied also in the CHIVA context.Method: 104 patients were investigated before and 3–6 months after the treatment of the great saphenous vein (GSV) with CHIVA strategy using enoluminal heat techniques to close the groin segment (VNUS Closure-Fast™ or LASER [1470 nm, Intros radial]). General data (age, sex, BMI) and phlebological data (QoL as reflected in VCSS, clinics as C[CEAP], refilling time after muscle pump measured with light reflection rheography, diameters of GSV at the groin and proximal thigh, as well as diameters of the common femoral vein) were measured and compared.Results: Significant reduction of diameters of GSV at proximal thigh from 6.5 ± 1.6 to 3.7 ± 1.1 and VFC from 15.2 ± 2.3 to 14.8 ± 2.2 were recorded, as well as reduction of clinical scores (VCSS from 5.6 ± 3.1 to 2.2 ± 2 and C[CEAP] from 3.2 ± 1 to 2.1 ± 1.1). Refilling time improved from 20.3 ± 11 to 28.8 ± 10.2. Results are comparable to those achieved after surgical crossectomy and published in other series.Conclusion: The disconnection of the insufficiency point at the saphenofemoral junction seems to be possible in the context of CHIVA Strategy applying endoluminal heat technique. No difference could be found between both techniques, Laser or VNUS Closure-Fast™.

Minor tributary veins of the common femoral vein near the saphenofemoral junction – A postmortem study

2020 ◽  
Vol 35 (10) ◽  
pp. 792-798
Author(s):  
Dominic Mühlberger ◽  
Achim Mumme ◽  
Markus Stücker ◽  
Erich Brenner ◽  
Thomas Hummel
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Ex Situ ◽  
Common Source ◽  
Vast Number ◽  
Common Femoral Vein ◽  
The Common ◽  
Saphenofemoral Junction

Objectives Recurrent varicose veins after surgery are a frequent burden and the saphenofemoral junction is the most common source of reflux. Pre-existing branches of the common femoral vein near the saphenofemoral junction, which may increase due to haemodynamic or other reasons, could play a role in the development of recurrent varices. There exist only a few anatomical data about the prevalence of these minor venous tributaries of the common femoral vein near the saphenofemoral junction. Therefore, this study aimed to elucidate their frequency and distribution. Method A total of 59 veins from 35 anatomical donors were dissected. The common femoral vein with the adherent parts of the profunda femoris vein and the great saphenous vein was exposed and analysed ex situ. The number of minor tributaries to the common femoral vein was counted and their distances to the saphenofemoral junction as well their diameters were measured. Results We could identify up to 10 minor tributaries of the common femoral vein below the level of the great saphenous vein as far as 6 cm distally and up to four veins above the level as far as 5 cm proximally. The mean diameters of these vessels ranged from 0.5 to 11.7 mm. Most of these vessels were located near the saphenofemoral junction and 3 cm distally. Directly opposite to the opening of the great saphenous vein we could find at least one minor tributary of the common femoral vein in 57%. Conclusions There exist a vast number of minor tributaries of the common femoral vein and they are mainly located near the saphenofemoral junction. Nevertheless, their role in the development of recurrent varices is still unclear and further studies are necessary.

Measuring diameters of great saphenous vein and common femoral vein using duplex ultrasound

Phlebologie ◽  
2014 ◽  
Vol 43 (05) ◽  
pp. 263-267
Author(s):  
E. Mendoza
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Femoral Vein ◽  
Duplex Ultrasound ◽  
Standing Position ◽  
Common Femoral Vein ◽  
Venous Diameter ◽  
The Common ◽  
Proximal Thigh ◽  
Transverse View

SummaryFor years, measurement of the diameter of the great saphenous vein and, occasionally, the common femoral vein has been a component of many clinical studies on varicose vein treatment. There is consensus that the measurements should be conducted with the patient in the standing position and with a transverse view through the vein, but no standardised site of measurement of the venous diameter has yet been established. The shape of the great saphenous vein varies greatly at the saphenofemoral junction. Due to the curvature of the great saphenous vein, it is difficult to find a point at which the transverse view measured is at right angles to the course of the vein. According to the available data, the optimal site for measuring the great saphenous vein diameter is the proximal thigh. When measuring the common femoral vein, a transverse view immediately distal to the junction of the great saphenous vein is suggested and studies have also confirmed this.

The ostial valve of the great saphenous vein

2011 ◽  
Vol 27 (4) ◽  
pp. 179-183 ◽  
Author(s):  
C Tasch ◽  
E Brenner
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Femoral Vein ◽  
Relevant Literature ◽  
Functional Anatomy ◽  
Common Femoral Vein ◽  
Venous Valves ◽  
The Common ◽  
Medical University ◽  
Clear Description

Background Venous valves have been classified into parietal (PVs) and ostial valves (OVs). PVs are located within the lumen of veins, whereas the OVs are located directly at the confluence of two veins. In the common femoral vein (CFV), the most prominent PVs are the suprasaphenic and infrasaphenic valve. The terminal valve (often designated as ‘valvule ostiale’ in the relevant literature in French) defined as that lying between the orifice of the great saphenous vein (GSV) and the most proximal of the major superficial tributary veins and the preterminal valve represent the most important PVs in the GSV. While PVs are well studied, there is not much literature on the OVs of the superficial venous system, especially of the GSV. Objective In order to investigate the presence of OVs (defined strictly as valves located at the entrance of a tributary vein) in the GSV, we carried out studies on specimens obtained from bodies bequested to the Division of Clinical and Functional Anatomy of Innsbruck Medical University. Methods Ninety-eight specimens consisting of the CFV and the attached tributary veins including the GSV were investigated. Results In five of these (5.1%), a single-cusped OV, in six (6.1%) a two-cusped OV and in 10 (10.2%) remnants of an OV were identified. Thus, OVs do not seem to be primarily present in all GSVs. Conclusion The distinction between PVs and OVs is not always clear in literature, and as a consequence misinterpretations may occur. Very often the terminal valve of the GSV, which is in fact a PV, is designated as an ‘ostial valve’. In view of its widespread use, we suggest that the term ‘ostial valve’ together with its clear description be included in the consensus documents of the ‘Union Internationale de Phlébologie’.

Venous Reflux at the Sapheno-Femoral Junction

1995 ◽  
Vol 10 (4) ◽  
pp. 132-135 ◽  
Author(s):  
G. M. Somjen ◽  
J. Donlan ◽  
J. Hurse ◽  
J. Bartholomew ◽  
A. H. Johnston ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Ultrasound Examination ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Duplex Ultrasound ◽  
Venous Reflux ◽  
Duplex Scan ◽  
Common Femoral Vein ◽  
Long Saphenous Vein ◽  
The Common

Objectives: To clarify reflux patterns in the sapheno-femoral junction in legs with varicose veins that display incompetence in the proximal long saphenous vein on duplex scan examination. Patients and method: One hundred consecutive extremities were selected for ultrasound studies. Venous reflux was examined in the common femoral vein and long saphenous vein at five selected levels in the vicinity of the sapheno-femoral junction. Results: Duplex ultrasound examination confirmed that in 44 extremities reflux was detectable both in the long saphenous vein and common femoral vein indicating ‘true’ sapheno-femoral incompetence. In 56 legs reflux was limited to the long saphenous vein, whilst the first saphenous valve remained competent. The ultrasound examination suggested that in these cases the reflux originated from the numerous tributaries of the proximal long saphenous vein. Conclusion: Our findings emphasize the transfascial escape (reflux from the deep veins) is not a necessary precondition of long saphenous vein incompetence and related varicose veins.

The role of circumflex femoral veins in the saphenofemoral junction incompetence: a case report

2011 ◽  
Vol 26 (3) ◽  
pp. 121-124
Author(s):  
F Passariello
Keyword(s):  
Great Saphenous Vein ◽  
Femoral Vein ◽  
Anatomical Variations ◽  
Iliac Vein ◽  
Lower Limbs ◽  
Valsalva Manoeuvre ◽  
External Iliac Vein ◽  
The Common ◽  
Saphenofemoral Junction

A 31 year-old female patient, an opera singer, came for a consultation, mainly for aesthetic problems of the lower limbs. An asymptomatic bilateral P-point pelvic shunt was demonstrated by the EchoDoppler, while no nutcracker syndrome was detected. The examination demonstrated a medial circumflex femoral vein (MCFV), going into the common femoral vein and then into the great saphenous vein (GSV). The Valsalva manoeuvre showed the GSV terminal valve incompetence. A dilated MCFV vein at the level of the saphenofemoral junction was the source of the reflux through the GSV, while the external iliac vein was competent. GSV reflux with Valsalva was present only in the lying position. Flow in the MCFV was directed toward the CFV during and after the Valsalva. The examination shows clearly that a GSV reflux can sometimes occur in absence of iliac reflux. Circumflex femoral veins (medial and lateral) are anatomical variations, but common findings during ordinary EchoColourDoppler investigations of the venous system of the lower limbs.

The classic saphenofemoral junction and its anatomical variations

2016 ◽  
Vol 32 (3) ◽  
pp. 172-178 ◽  
Author(s):  
Panos Souroullas ◽  
Rachel Barnes ◽  
George Smith ◽  
Sandip Nandhra ◽  
Dan Carradice ◽  
...  
Keyword(s):  
Varicose Veins ◽  
Femoral Vein ◽  
Anatomical Variations ◽  
Median Number ◽  
Consecutive Series ◽  
Recurrence Rates ◽  
Common Femoral Vein ◽  
Anterolateral Thigh ◽  
The Common ◽  
Saphenofemoral Junction

Background The intraoperative anatomy of the saphenofemoral junction can vary from the ‘textbook’ description of six independent proximal tributaries: three medial – superficial external pudendal, deep external pudendal and the posteromedial thigh branch – and three lateral – superficial epigastric, superficial circumflex iliac and the anterolateral thigh branch. Varicose veins can recur following inadequate initial open surgery with failure to identify, ligate and divide these tributaries. An appreciation of common anatomical variations could minimise recurrence rates following surgery. This study aimed to identify common anatomical variations within our patient cohort. Methods This prospective observational study documented diagrammatically the anatomy of saphenofemoral junction in a consecutive series of 172 patients undergoing unilateral, primary saphenofemoral junction ligation for symptomatic superficial venous insufficiency. Diagrams recorded the number of tributaries and their relationship to the saphenofemoral junction, the existence of bifid systems and the relationship of the external pudendal artery to the saphenofemoral junction. Results In sum, 110 women and 62 men with a mean age of 47.2 (IQR 21–77) years were studied. The median number of saphenofemoral junction tributaries was 4 (IQR 0–7). In 74 cases (43.0%), at least one tributary drained directly into the common femoral vein (IQR 0–4), commonly the deep external pudendal (91.9%). The anterolateral thigh branch was identified in 62 cases (35.8%) and the posteromedial thigh branch in 93 cases (53.8%). The external pudendal artery was identified in 150 cases (87.2%) and was superficial to the great saphenous vein in 36 cases (20.9%). Conclusions Significant variations exist in the saphenofemoral junction anatomy. Familiarity with anatomical saphenofemoral junction variations is imperative to ensure operative success and reduce recurrence. Thorough dissection of the common femoral vein is necessary not only to ensure all proximal tributaries are identified and ligated but also as a safety mechanism in preventing avulsion trauma of direct common femoral vein tributaries.

Thrombophlebitis of the great saphenous vein – recommendations for treatment

2008 ◽  
Vol 23 (1) ◽  
pp. 35-39 ◽  
Author(s):  
S L Hill ◽  
D H Hancock ◽  
T L Webb
Keyword(s):  
Lower Extremity ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Femoral Vein ◽  
Bed Rest ◽  
Duplex Scan ◽  
Superficial Thrombophlebitis ◽  
The Common ◽  
Level I ◽  
One Year

Objectives The purpose of this study was to evaluate the incidence of great saphenous vein (GSV) thrombosis in symptomatic patients and its possible relationship to complications usually attributed to deep venous thrombosis (DVT). Methods To quantitate the frequency of GSV thrombosis and evaluate its possible morbidity, we reviewed all the venous studies, both inpatient and outpatient, at a Level I Trauma Center over one year. The charts of all patients who had a thrombus in the GSV, either alone or in combination with a DVT, were examined. Results A total of 2646 lower extremity venous scans were done in the year studied. In this group, there were 388 (14.5%) positive studies for a DVT. There were 36 (9.3%) patients in this group who had a DVT of the lower extremity and a thrombus in the GSV. In the total group, there were 30 patients (1.1%) with a superficial thrombophlebitis of the GSV alone. In these patients, 22 (73%) either showed cephalad progression of the thrombus, symptoms of shortness of breath, a mobile tip in the thrombus or extension of the thrombus into the common femoral vein. Five patients (16.6%), after failing medical therapy (heparin, bed rest and antibiotics), underwent surgical treatment. Conclusions Thrombophlebitis of the GSV, although not very common, needs to be carefully followed with a repeat duplex scan to determine if there is propagation of the thrombus. This study shows that thrombophlebitis of the GSV can cause many of the complications attributed to deep venous thrombi and, therefore, must be thoroughly evaluated, followed, and, if necessary, treated.

Sign in / Sign up

Export Citation Format

Share Document