Midterm results of the surgical treatment of varices by phlebectomy with conservation of a refluxing saphenous vein

Abstract

A new physiopathologic concept within superficial venous insufficiency (SVI) describes ascending progression from the collaterals to the saphenous veins (SV), leading to a treatment that aims to remove the varicose reservoir and not the SVs. This study reports the midterm results of this therapeutic approach. This is a retrospective study of patients treated for varices by phlebectomy with conservation of a refluxing SV before July 2004. We evaluated the varicose reservoir by determining the number of zones to be treated (NZT); each lower limb was divided into 32 zones in the preoperative mapping. We performed a clinical and duplex ultrasound examination after 6 months and 1 year, and then once a year until year 4. Amongst 811 lower limbs operated on for first-time varicose veins, 303 in 221 patients (55 men; 166 women), mean age, 52.7 years (range, 20-93 years), were treated by phlebectomy, with conservation of a refluxing SV. All lower limbs operated on presented preoperative SV reflux >0.5 seconds: great SV (GSV), 85.8%; small SV (SSV), 11.9%; and GSV and SSV, 2.3%. The average NZT was 6.05 (range, 2-10). SV reflux was reduced to < 0.5 seconds in 69.6%, 69.2%, 68.7%, 68.0%, and 66.3% of limbs, respectively, after 6 months, 1, 2, 3, and 4 years of follow-up. Symptoms improved or disappeared in 84.2%, 84.2%, 83.4%, 81.4%, and 78.0% of limbs at each annual check-up until year 4. Freedom of varices recurrence was 95.5%, 94.6%, 91.5%, and 88.5%, respectively at 1, 2, 3, and 4 years. When the NZT was >7, the postoperative varicose recurrence was more frequent (odds ratio, 6.82; P = .0001), and the postoperative elimination of SV reflux was more frequent (odds ratio, 4; P = .037) as was symptoms improvement (odds ratio, 2.91; P = .004). When an ostiotruncal SV reflux extended to the malleolus preoperatively, the elimination of the SV reflux was less frequent (47.6% vs 70.3%; P < .05). Ablation of the varicose reservoir with conservation of a refluxing SV can be an effective treatment in the midterm for the signs and symptoms of SVI and leads to nonsignificant SV reflux in more than two of three cases. The extent of the varicose reservoir ablation is the key factor determining the hemodynamic and clinical efficacy of this more limited surgical approach.