Cyanoacrylate Glue Ablation of Perforating Veins in Patients with Recurrent Varicose Veins of the Lower Extremities: A Prospective Study

Chronic Venous Insufficiency

Recurrent Varicose Veins Following High Ligation of Long Saphenous Vein: A Duplex Ultrasound Study

Recurrent varicose veins following high ligation of long saphenous vein: a duplex ultrasound study

Evaluation of the Clinical Anatomy of the Most Important Perforator Veins of the Lower Extremities by Dissection and Duplex Ultrasound Scanning

Objective To summarize the etiologic factors and evaluate the clinical outcome of reoperations on 119 limbs of recurrent varicose veins.Methods Retrospective analysis was made on etiologic factors of 119 limbs (113 patients) of recurrent varicose veins admitted to our hospital from January 2007 to June 2013.All patients underwent color duplex ultrasonography and anterograde venography of the lower extremity and were treated by reoperations.Results In the 119 limbs,102 limbs (85.7％) had residual main great saphenous veins or tributaries,97 limbs (81.5％) had incompetent perforator veins,23 limbs (19.3％) had neovascularization,9 limbs (7.6％) had incompetent small saphenous veins,21 limbs (17.6％) had incompetent femoral veins,6 limbs (5.0％) had iliac vein compression syndrome,and Budd Chiari syndrome was found as the cause of recurrence in 1 limb (0.8％).Postoperative patients were followed-up for 6-72 m (32-± 7 m).The cure rate of varicose veins were 100％.There was not recurrence of varicose veins,postoperative VCSS was 0-5 (1.2 ±0.5) vs preoperative 1-17 (6.2 ±2.5)(P ＜ 0.01).Conclusions Residual and incompetent great saphenous veins or tributaries and incompetent perforator veins were the main etiologic factors of postoperative recurrent varicose veins.Therapeutic principle for recurrent varicose veins is to eliminating the reverse flow of superficial vein system and ligate incompetent perforator veins. Key words: Varicose veins; Recurrence; Reoperation; Neovascularization

Incompetent perforating veins are associated with recurrent varicose veins.

Validation of duplex ultrasonography in detecting competent and incompetent perforating veins in patients with venous ulceration of the lower leg.

New Insights into Perforator Vein Incompetence

Regarding “Balloon control of the saphenofemoral junction during foam sclerotherapy: Proposed innovation”

Introduction: Subfascial Endoscopic Perforator Surgery (SEPS) is a minimally invasive technique to treat incompetent perforating veins. Incompetent perforators are implicated in venous ulcer and in varicose veins recurrence. Complete closure of all perforating veins is the only predictor of ulcer healing. Analysis of our results is the objective of this study. Methods: Fifty (50) patients with incompetent perforating veins were submitted to unilateral SEPS. Class CEAP C2-C6 patients were included. Ulcer-healing rate, ulcer recurrence rate, and complications rate were analysed. Results: CEAP distribution was: C1–0; C2–5; C3–20; C4–11; C5–2; C6–12. An ulcer-healing rate of 92% (11/12) was found at 6 months, with an average of 2.5 months until complete cicatrisation. Only one patient suffered an ulcer recurrence (9%). Complications occurred in 4 patients (8%), including 2 cases of surgical site infection (4%). Discussion: SEPS has a better ulcer-healing rate than other perforator ablation techniques. Our data match other studies data. The inclusion of patients submitted to SEPS plus GSV stripping and patients submitted only to SEPS can bring some doubts about the role of SEPS in ulcer healing. However from the patients treated only with SEPS, most of them had already been submitted to GSV removal in the past, and were now treated because of venous ulcer development and varicose veins recurrence. Conclusion: These data support the importance of SEPS in perforating veins treatment and the hemodynamic role of perforators in venous ulcer development and varicose veins recurrence.

Abstract. Introduction. Chronic venous insufficiency (CVI) of the extremities is an extremely important current problem from a medical, social and economic point of view due to the high prevalence of this pathology. In the pathogenesis of CVI, 4 main mechanisms play the greatest role: proximal obstruction in deep veins, valve failure in superficial veins, valve failure in deep veins, and perforating vein valve failure (PV). Current understanding of the pathogenesis of CVI indicates that the presence of pathological horizontal and vertical venous refluxes is one of the most important links in the complex chain of venous insufficiency. Despite the improvement of methods for diagnosing and treating chronic venous insufficiency of the lower extremities, this problem remains relevant and has not been fully resolved. Until recently, X-ray contrast phlebography was central to the diagnosis of valvular insufficiency of the venous system and its topical localization. its topical localization. The current standard examination of patients with chronic venous disease is ultrasound duplex examination. Aim. Improving the results of treatment of patients with chronic lower extremity vein diseases with signs of post-thrombophlebitic syndrome by developing a modern diagnostic algorithm and new treatment technologies. Materials and methods. The study was based on the results of surgical treatment of 102 patients with PTFD of the lower extremities in the decompensated stage of CVI who had not been operated on before. Common to all patients was the presence of trophic disorders of the soft tissues of the lower leg of varying severity (C4-6 class according to the SEAR) and insufficiency of the perforating veins of the lower leg, detected during the examination. Depending on the method of eliminating low horizontal veno-venous discharge, patients were divided into two groups: the main group and the comparison group. A prerequisite was an ultrasound comprehensive examination of the veins of both lower extremities. The diagnostic algorithm necessarily included an assessment of changes in blood flow under the influence of functional tests to evaluate the patency of the segment under study, the functional capacity of the valve apparatus. The presence of complications in the early and late postoperative period, the length of hospital stay, and the duration of surgery were also assessed. Research results and discussion. According to the results of ultrasound duplex scanning with color Doppler mapping (CDM), the most frequently failed perforating veins were found in the Cockett zone and in the middle third of the lower leg. The nature of the combined venectomy in the system of the great saphenous vein (GSV) and the small saphenous vein (SSV), performed in combination with dissection of perforating veins (PV), was determined individually in each case. The choice of surgical access was determined depending on the localization of failed PVs and the prevalence of soft tissue DVT, which were determined on the basis of ultrasound duplex angioscopy (USDA) of the lower extremity veins. All stages of surgical treatment in both groups were performed under ultrasound navigation in the “4-hand” mode, which frees the surgeon’s hands during surgery. The surgical treatment of patients in the comparison group was combined and consisted of simultaneous endoscopic dissection of failed PVs and various modifications of phlebectomy and sclerotherapy. Conclusions. The paper presents data on the solution of an urgent scientific and practical problem of modern surgery – improvement of treatment outcomes in patients with decompensated forms of chronic venous insufficiency in post-thrombophlebitic disease through the use of differentiated pathogenetically based surgical tactics based on ultrasound navigation data in the preoperative, intraoperative and postoperative stages of patient management.

It has long been noted that incompetent perforating veins contribute to the development of chronic venous insufficiency and recurrent varicose veins that are complicated by skin ulcerations or liposcleroderma. For these conditions, severing of incompetent perforating veins is an effective surgical treatment. However, severing of incompetent perforating veins by a direct approach has become less commonly performed because of the excessive invasiveness of the procedure itself. We referred to 37 cases (44 legs) of varicose veins with or without active venous dermatitis, who underwent the two-port system subfascial endoscopic perforator surgery, which we devised (hereafter referred to as TPS-SEPS). According to this method, incompetent perforating veins can be severed without surgical intervention in the lesion. The criteria for insufficiency of the perforating veins (IPVs) are reverse flow demonstrated on a color-flow duplex and a caliber more than 3 mm in diameter. One hundred forty one out of one hundred fifty two IPVs were processed. A mean of 3.21 perforating veins per patient was severed using ultrasonic coagulation-incision apparatus. From these 37 cases we conclude that TPS-SEPS provides a useful tool for the surgeon interested in treating severe chronic venous insufficiency same as the single-port technique. Our TPS-SEPS is a relatively simple operation, but its skill is dependable and provides lower invasiveness than other operation procedure. From now on, it is necessary to unify the authorized name of the endoscopic surgery of perforating veins and is also important to define the indication of this method for the primary varicose veins without stasisdermatitis.

It has long been noted that incompetent perforating veins contribute to the development of chronic venous insufficiency and recurrent varicose veins that are complicated by skin ulcerations or liposcleroderma. For these conditions, severing of incompetent perforating veins is an effective surgical treatment. However, severing of incompetent perforating veins by a direct approach has become less commonly performed because of the excessive invasiveness of the procedure itself. We referred to 37 cases (44 legs) of varicose veins with or without active venous dermatitis, who underwent the two-port system subfascial endoscopic perforator surgery, which we devised (hereafter referred to as TPS-SEPS). According to this method, incompetent perforating veins can be severed without surgical intervention in the lesion. The criteria for insufficiency of the perforating veins (IPVs) are reverse flow demonstrated on a color-flow duplex and a caliber more than 3 mm in diameter. One hundred forty one out of one hundred fifty two IPVs were processed. A mean of 3.21 perforating veins per patient was severed using ultrasonic coagulation-incision apparatus. From these 37 cases we conclude that TPS-SEPS provides a useful tool for the surgeon interested in treating severe chronic venous insufficiency same as the single-port technique. Our TPS-SEPS is a relatively simple operation, but its skill is dependable and provides lower invasiveness than other operation procedure. From now on, it is necessary to unify the authorized name of the endoscopic surgery of perforating veins and is also important to define the indication of this method for the primary varicose veins without stasisdermatitis.

Prevalence and distribution of incompetent perforating veins in chronic venous insufficiency

Ovarian vein embolization in recurrent varicose veins - how invasive should varicose treatment be?