scholarly journals Comment to: Diameter reduction of the great saphenous vein and the common femoral vein after CHIVA long-term results, by Mendoza E. Phlebologie 2013;42:65–69.

2013 ◽  
Vol 2 (1) ◽  
pp. 5
Author(s):  
Stefano Ricci
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Femoral Vein ◽  
Long Term Results ◽  
Common Femoral Vein ◽  
The Common ◽  
Diameter Reduction

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’.

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™.

Is catheter-directed foam sclerotherapy more effective than the usual foam sclerotherapy for treatment of the great saphenous vein?

2018 ◽  
Vol 33 (9) ◽  
pp. 646-652 ◽  
Author(s):  
Orsini Camillo
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Statistical Significance ◽  
Long Term Results ◽  
Complication Rates ◽  
Foam Sclerotherapy ◽  
Occlusion Rate ◽  
Long Term Experience

Objective This retrospective study presents the long-term results of catheter-directed foam sclerotherapy of the great saphenous vein. Method From January 2003 to June 2017, 277 patients with varices and great saphenous vein incompetence were treated with echo-guided foam sclerotherapy. Forty-six patients were treated with long-catheters guided by foam sclerotherapy. Foaming was carried out with sodium-tetra-decyl-sulphate. Results Results were examined in the two groups: A (long-catheters) and B (other procedures). The median overall follow-up was 52.1 months. In the A-group, the complete occlusion rate was 34/46 pts (73.9%) and partial occlusion was 10/46 (21.7%). In the B-group, respectively, 130/231 (56.2%) and 90/231 (38.9%). Comparisons between groups were statistically significant (p = 0.023; p = 0.021). Failures involved, respectively, 2/46 (4.3%) and 11/231 (4.7%) with no statistical significance. The complication rates were similar in the two groups. Conclusions In this long-term experience (median follow-up exceeding four years), foam-guided sclerotherapy of the great saphenous vein with a long-catheter turned out to be more effective than the usual foam-guided sclerotherapy.

Five-year outcomes of mechano-chemical ablation of primary great saphenous vein incompetence

2019 ◽  
Vol 35 (4) ◽  
pp. 255-261
Author(s):  
Naomi DE Thierens ◽  
Suzanne Holewijn ◽  
Wynand HPM Vissers ◽  
Debbie AB Werson ◽  
Jean Paul PM de Vries ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Clinical Severity ◽  
Long Term Results ◽  
Venous Clinical Severity Score ◽  
Ceap Classification ◽  
Chemical Ablation ◽  
Anatomical Success

Objective The aim of the study is to report long-term results after mechano-chemical ablation for the treatment of great saphenous vein incompetence. Methods Mechano-chemical ablation was performed using the ClariVein device with polidocanol as the sclerosant. Clinical-Etiologic-Anatomic-Pathophysiologic (CEAP) classification, Venous-Clinical-Severity-Score (VCSS), anatomical-success, RAND-SF36 and the Aberdeen-Varicose-Vein-Questionnaire (AVVQ) were obtained by clinical examination, questionnaires and duplex ultrasonography through five years’ follow-up (Clinicaltrials.gov, NCT01459263). Results Ninety-four patients (113 great saphenous veins) were included in the study. Five-year follow-up data were available for 75 limbs (66.4%). Freedom from anatomical failure was 78.7% (N = 45) with 64.6% (N = 42) having an improvement in the VCSS ≥1. A total of five reinterventions were performed through five years with a median time to reintervention of 38 months. The VCSS at five years was 2 (IQR 1; 4) and was still significantly improved compared to baseline (p < 0.001). A deterioration of the VCSS was observed in 21.5%. Conclusion Through five-year follow-up, there are a significant number of anatomical and clinical failures in this series, mainly driven by partial recanalizations.

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

1991 ◽  
Vol 6 (3) ◽  
pp. 159-165 ◽  
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.

Long-term results after radiofrequency ablation in 1998

Phlebologie ◽  
2014 ◽  
Vol 43 (04) ◽  
pp. 197-200
Author(s):  
A. Brunner ◽  
J. Noppeney ◽  
T. Noppeney
Keyword(s):  
Radiofrequency Ablation ◽  
Clinical Examination ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Lower Leg ◽  
Entire Length ◽  
Long Term Results ◽  
The Mean

Summary Introduction: In 1998, radiofrequency ablation (VNUS Closure Plus™) was authorised in Germany and Europe for the treatment of superficial reflux. We participated in a clinical registry set up by the manufacturing company in 1998. The aim of this retrospective paper was to analyse the long-term results after radiofrequency ablation. Materials, methods and patients: In 1998, we operated on twelve patients (8 women, 4 men). In accordance with the concept of standard vein stripping surgery, all endovenous ablations were combined with crossectomy or ligature of the saphenopopliteal junction. Each vein was thermally ablated over its entire length and no tumescent anaesthesia was performed. The mean age of the twelve patients was 44.9 years. On ten occasions, the entire length of the great saphenous vein was treated, on one occasion the great saphenous vein at the level of the lower leg and on one occasion the entire length of the small saphenous vein. The mean duration of surgery was 80 minutes. Results: The follow-up period was 3 to 168 months, with a mean duration of 80 months. Six patients were followed up for longer than 120 months. In eight cases, the follow-up examination was performed using duplex ultrasound, in two cases using clinical examination and non-invasive testing, in one case using clinical examination and in one case via a telephone interview.The most frequent perioperative complication, occurring in six cases, was hypaesthesia at the medial malleolus or lower leg. There was one case of perioperative thrombophlebitis of a lateral branch in the lower leg and one case of a third-degree thigh burn with subsequent infection of the great saphenous vein canal. No deep vein thrombosis or pulmonary embolism occurred in any of the operated patients.Of the eleven great saphenous veins treated, one recanalised after 14 months, the others had closed or were no longer detectable on ultrasound. The small saphenous vein treated was also no longer detectable.In one patient, a major recurrence at the saphenofemoral junction with recurrent lateral branches in the thigh and lower leg were determined 168 months after surgery. No recurrent varicosis was determined in the other patients.

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