A New Method to Shorten the Remnant Stump with Cyanoacrylate Closure of Great Saphenous Vein

It is known from current pathophysiology that disease stages I and II of truncal varicosity of the great saphenous vein do not cause changes in venous pressure on dynamic phlebodynamometry. This is possibly also the case for mild cases of the disease in stage III. In pronounced cases of stage III and all cases of stage IV, however, venous hypertension occurs which triggers the symptoms of secondary deep venous insufficiency and all the complications of chronic venous insufficiency. From these facts the therapeutic consequence is inferred that in stages I and II and perhaps also in very mild cases of stage III disease, it is enough "merely" to remove varicose veins without expecting there to be any other serious complications in the patient’s further life caused by the varicosity. Recurrence rates are not included in this analysis. In marked cases of disease stages III and IV of the great saphenous vein, however, secondary deep venous insufficiency is to be expected sooner or later. The classical operation with saphenofemoral high ligation ("crossectomy") and stripping strictly adheres to the recognized pathophysiologic principles. It also takes into account in the greatest detail aspects of minimally invasive surgery and esthetics. In the past few years, developments have been advanced to further minimize surgical trauma and to replace the stripping maneuver using occlusion of the trunk vein which is left in place. Obliteration of the vessel is subsequently performed via transmission of energy through an inserted catheter. This includes the techniques of radiofrequency ablation and endovenous laser treatment. High ligation is not performed as a matter of principle. In a similar way, sclerotherapy using microfoam is minimally invasive in character. All these procedures may be indicated for disease stages I and II, and with reservations also in mild forms of stage III disease. Perhaps high ligation previously constituted overtreatment in some cases. Targeted studies are still needed to prove whether secondary deep venous insufficiency can be avoided in advanced stages of varicose vein disease without high ligation and thus without exclusion of the whole recirculation circuit.

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Malignant tumours as a rare cause of recurrent thrombophlebitis of the great saphenous vein

Phlebologie ◽

10.1055/s-0037-1622244 ◽

2008 ◽

Vol 37 (06) ◽

pp. 297-300

Author(s):

N. König ◽

H. J. Stark ◽

P.-M. Baier

Keyword(s):

Differential Diagnosis ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Case Reports ◽

Malignant Tumours ◽

Nerve Sheath Tumour ◽

Below The Knee ◽

Nerve Sheath ◽

Unfavourable Prognosis ◽

Peripheral Nerve Sheath Tumour

SummaryWe present two case reports concerning patients who had to undergone surgical treatment according tp the diagnosis of thrombophlebitis with insufficiency of the greater saphenous vein and putative encapsulated haematoma in the lower left leg area. During the operation we found tumours with urgent suspicion of malignancy. The histological examination revealed the diagnosis of mesenchymal chondrosarcoma and malignant peripheral nerve sheath tumour which are extremely malignant, but very rare neoplasmas with unfavourable prognosis. Conclusion: Since both types of tumours are often located below the knee, phlebotomists and vascular surgeons should take them into account as differential diagnosis.

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Short stripping of the incompetent great saphenous vein by InvisiGrip® vein stripper

Phlebologie ◽

10.1055/s-0037-1622295 ◽

2010 ◽

Vol 39 (02) ◽

pp. 77-81 ◽

Cited By ~ 1

Author(s):

A. G. Krasznai ◽

E. C. M. Bollen ◽

J. C. van der Kley ◽

R. J. Th. J. Welten ◽

G. M. J. M. Welten

Keyword(s):

Success Rate ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Femoral Nerve ◽

Preoperative Selection ◽

Superficial Wound ◽

Good Cosmetic ◽

Surgical Device ◽

Femoral Nerve Injury ◽

Selection Of

SummaryOur aim is to describe the results of a new short stripping technique for the treatment of the incompetent great saphenous vein (GSV) using a new developed surgical device. Patients, methods: 397 patients (498 legs) were treated with the InvisiGrip® Vein Stripper, which removes the GSV through a single groin incision, endovascular cutting and antegrade stripping by inversion. We reported the surgical success rate and postprocedural complications. Results: The mean age was 51 years, 74% were women. The success rate for removal of the GSV was 95%. The 23 failures were half patient related, half device related. In 82% of the strippings, one or two attempts were needed to successfully remove the GSV, which was done by invagination in 80%. Age, gender, BMI ≥30 kg/m2 and male GSV diameter were not associated with the number of attempts. Superficial wound infection, haematoma and temporary saphenous and femoral nerve injury occurred in 6 (1.6%), 0, 3 (0.8%) and 7 (1.9%) patients, respectively. Conclusion: The InvisiGrip® is highly successful for the removal of the GSV using short inverting stripping. Furthermore, it is simple, safe, associated with good cosmetic results and no preoperative selection of patients is necessary.

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Sonographically guided, transcatheter foam sclerotherapy of the great saphenous vein

Phlebologie ◽

10.1055/s-0037-1622198 ◽

2007 ◽

Vol 36 (06) ◽

pp. 309-312 ◽

Cited By ~ 11

Author(s):

T. Schulz ◽

M. Jünger ◽

M. Hahn

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Clinical Stage ◽

Clinical Signs ◽

Cost Effective ◽

Duplex Sonography ◽

Foam Sclerotherapy ◽

Average Loss ◽

One Year ◽

The Cost

Summary Objective: The goal of the study was to assess the effectiveness and patient tolerability of single-session, sonographically guided, transcatheter foam sclerotherapy and to evaluate its economic impact. Patients, methods: We treated 20 patients with a total of 22 varicoses of the great saphenous vein (GSV) in Hach stage III-IV, clinical stage C2-C5 and a mean GSV diameter of 9 mm (range: 7 to 13 mm). We used 10 ml 3% Aethoxysklerol®. Additional varicoses of the auxiliary veins of the GSV were sclerosed immediately afterwards. Results: The occlusion rate in the treated GSVs was 100% one week after therapy as demonstrated with duplex sonography. The cost of the procedure was 207.91 E including follow-up visit, with an average loss of working time of 0.6 days. After one year one patient showed clinical signs of recurrent varicosis in the GSV; duplex sonography showed reflux in the region of the saphenofemoral junction in a total of seven patients (32% of the treated GSVs). Conclusion: Transcatheter foam sclerotherapy of the GSV is a cost-effective, safe method of treating varicoses of GSV and broadens the spectrum of therapeutic options. Relapses can be re-treated inexpensively with sclerotherapy.

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Fibrinolytic Activity of Human Veins in Arms and Legs

Thrombosis and Haemostasis ◽

10.1055/s-0038-1651264 ◽

1968 ◽

Vol 20 (01/02) ◽

pp. 247-256 ◽

Cited By ~ 24

Author(s):

M Pandolfi ◽

B Robertson ◽

S Isacson ◽

Inga Marie Nilsson

Keyword(s):

Saphenous Vein ◽

Fibrinolytic Activity ◽

Great Saphenous Vein ◽

Normal Subjects ◽

Vasa Vasorum ◽

Tissue Sections ◽

Below The Knee ◽

The Media

SummaryA modification of the fibrin slide method of Todd permitting a semiquantitative estimation of the fibrinolytic activity in tissue sections is described. By means of this technique, the authors have studied the fibrinolytic activity of the great saphenous vein and of superficial veins of the arm and leg in patients suffering from varices and in normal subjects. It was found that:1. Fibrinolytic activity is localized, in these vessels, mainly to the vasa vasorum of the adventitia. The media is moderately active. Intimal cells are active only when detached.2. The great saphenous vein is more active above than below the knee.3. The veins of the arm are definitely more active than the veins of the leg.4. The activator of plasminogen demonstrated in the sections by the fibrin slide method is a fairly stable enzyme still active after exposure to 60° C and resistent to moderate variations of pH.

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Risk factors for endovenous heat-induced thrombosis after endovenous radiofrequency ablation of the great saphenous vein

Acta Phlebologica ◽

10.23736/s1593-232x.19.00436-3 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Raffaele Serra ◽

Nicola Ielapi ◽

Tiberio Rocca ◽

Luca Traina ◽

Stefano De Franciscis ◽

...

Keyword(s):

Risk Factors ◽

Radiofrequency Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein

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Morphometric characteristics of competent proximal valves of the great saphenous vein and superficial femoral vein in vivo according to ultrasound angioscanning data

Regional blood circulation and microcirculation ◽

10.24884/1682-6655-2019-18-3-16-22 ◽

2019 ◽

Vol 18 (3) ◽

pp. 16-22

Author(s):

E. K. Gavrilov ◽

H. L. Bolotokov ◽

E. A. Babinets

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Femoral Vein ◽

Lower Boundary ◽

Average Diameter ◽

Lower Limbs ◽

Functional Test ◽

Natural Form ◽

Superficial Femoral Vein ◽

Venous Diameter

Introduction. It seems relevant to study the ultrasound anatomy and physiology of the proximal valve segments of the superficial femoral vein (SFV) and the great saphenous vein (GSV) to develop effective reconstructive surgical interventions on venous valves in chronic vein diseases.The aim of the survey was to study the ultrasound anatomy of the venous wall, the size and shape of the proximal SFV and GSV valves are normal at rest and during the functional test Valsalva.Material and methods. Proximal valve SFV studies were performed in 144 lower limbs in 115 people (mean age 51.1 ± 14.4 years, 60 women and 55 men), proximal GSV valves studies - in 82 lower limbs in 67 persons (average age 45, 1 ± 13.3 years, 33 women, 34 men). A longitudinal and transverse ultrasound scanning of the femoral vein bifurcation and safenofemoral junction areas were performed, the structures of the proximal SFV and GSV valves were visualized, the valve shape was measured and the diameter of the veins was measured at the level valves at the base of the valves (inlet diameter), at the point of maximum ectasia (diameter of ectasia), at the upper border of the valve (diameter of the outlet), as well as measuring the length of the valve a (length to ectasia, the total length of the valve). The degree of ectasia over the valve was judged by calculating the relative venous diameter change (RVDC).Results. the average diameter of the SFV at the level of the lower boundary of its first valve was 10.01 ± 1.44 mm. The average diameter of the SFV at the level of the maximum ectasia of its first valve was 13,1±2 mm. The average value of the index of RVDC for SFV was 31%±10,4%. An increase in the diameter of the vein in the zone of supravalvular ectasia up to 20% corresponded to the spindle-shaped valve, more than 20% - to the clavate form, which was noted in the majority of the examined. The change in the relative venous diameter of the SFV on the Valsalva test was 38,2%±12,4%. The average diameter of the GSV at the base of the first valves was 6,07±1,25 mm. The average diameter of the GSV at the level of the maximum ectasia of the osteal valve was 9,44±1,69 mm. The average RVDC for GSV was 58%±24%.Conclusion. the natural form of proximal SFV and GSV valves is clavate with presence of the significant supravalvular ectasia, which was noted in the majority of the subjects alone and in all during the performance of the Valsalva functional test.

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