Great Saphenous Vein Diameter Research Articles

Strategies to reduce rates of severe endothermal heat-induced thrombosis following radiofrequency ablation

ObjectiveEndothermal heat-induced thrombosis (EHIT) is a potential complication of radiofrequency ablation (RFA). Data on effective prophylaxis of EHIT are limited. In 2018, a high-volume, single institution implemented strategies to decrease the incidence of EHIT, including a single periprocedural prophylactic dose of low-molecular-weight heparin to patients with a great saphenous vein (GSV) diameter of ≥8 mm or saphenofemoral junction (SFJ) diameter of ≥10 mm and limiting treatment to one vein per procedure. The size threshold was derived from existing literature. The study objective was to evaluate the effects of these institutional changes on thrombotic complication rates after RFA. MethodsA retrospective cohort control study was conducted using the Vascular Quality Initiative database. Data were collected for patients who underwent RFA with a GSV diameter of ≥8 mm or SFJ diameter of ≥10 mm from January 2015 to July 2022. The clinical end points were thrombotic complications (ie, thrombophlebitis, EHIT, deep vein thrombosis) and bleeding complications. Patient demographic and procedural variables were included in the analysis, and significant variables after univariable logistic regression were included in a multivariable logistic regression. ResultsAfter the policy change, the overall vein center EHIT rate decreased from 2.6% to 1.5%, with a trend toward significance (P = .096). The inclusion criterion of a GSV diameter of ≥8 mm or an SFJ diameter of ≥10 mm yielded 845 patients, of whom 298 were treated before the policy change and 547 after. There was a significant reduction in the rate of EHIT classified as class ≥III (2.34 vs 0.366; P = .020) after the institutional changes. Treatment of two or more veins and an increased vein diameter were associated with an increased risk of EHIT (P = .049 and P < .001, respectively). No significant association was found between periprocedural anticoagulation and all-cause thrombotic complications or EHIT (P = .563 and P = .885, respectively). ConclusionsThe institutional policy changes have led to lower rates of EHIT, with a reduction in severe EHIT rates in patients with an ≥8-mm diameter GSV or a ≥10-mm diameter SFJ treated with RFA. Of the changes implemented, restricting treatment to one vein was associated with a reduction in severe EHIT. No association was found with periprocedural low-molecular-weight heparin, although a type 2 error might have occurred. Alternative strategies to prevent thrombotic complications should be explored, such as increasing the dosage and duration of periprocedural anticoagulation, antiplatelet use, and nonpharmacologic strategies.

Long-Term Clinical and Imaging Findings in Patients with Lower Extremity Varicose Veins Treated with Endovenous Laser Treatment: A Follow-Up Study of up to 12 Years.

This study investigates the long-term effectiveness and safety of endovenous laser treatment (EVLT) for chronic venous insufficiency (CVI), a condition commonly caused by dysfunctional valves in the venous circulation system. In this retrospective cohort study, patients underwent EVLT and were followed up for successive short intervals and one last time after a median duration of 9-year postprocedural. Pre- and postprocedure duplex ultrasound was used to assess changes in the great saphenous vein (GSV) diameter, reflux, and saphenofemoral junction incompetence. Quality of life was evaluated using the SF-36 and Aberdeen Varicose Vein Questionnaire (AVVQ). Sixty-eight patients with a mean age of 52.4 ± 12.4 years were enrolled in the study. The mean follow-up time was 8.9 ± 2.1 years, ranging from 5 to 12 years. The mean GSV diameter significantly decreased in all patients (whole group) across proximal (from 5.8 ± 2.3 mm to 4.2 ± 2.1 mm), middle (from 4.7 ± 1.6 mm to 2.8 ± 2.2 mm), and distal (from 4.5 ± 2.3 mm to 2.2 ± 2.2 mm) segments, with P < 0.001. A disease recurrence rate of 33.8% was noted, predominantly in male patients and those with larger middle GSV diameters (OR = 5.2 (95%CI = 1.3-20.4) and OR = 1.5 (95%CI = 1-2.1), respectively). The average follow-up time for patients without recurrence was 8.8 ± 2.1 years. Almost half of the patients without recurrence were followed up for 10 years or more (49%). The efficacy of EVLT in managing varicose veins is demonstrated by its relatively low recurrence rate over a 10-year follow-up period, highlighting EVLT as a viable long-term treatment strategy.

Should varicocele screening be conducted in men diagnosed with chronic venous insufficiency? A prospective study.

It has been previously proposed in numerous studies that chronic venous insufficiency (CVI) has similar pathogenesis to varicocele in males. Varicocele has been identified as the most common cause of infertility in men, accounting for 40% of cases. This study investigates whether varicocele screening should be conducted in patients with CVI and, if so, which patients should undergo such screening. The study included 102 adult male patients with venous insufficiency complaints who presented to the cardiovascular surgery clinic between January 2023 and June 2023. Data were prospectively collected through medical history interviews and Doppler ultrasound measurements performed by a single radiologist. The relationship between non-normally distributed measurement data of the two groups was evaluated using the Mann-Whitney U test, while the association between categorical variables was assessed using the χ2 test. ROC analysis was employed for determining predictive value. A type 1 error level of α = 0.05 was adopted. The mean left great saphenous vein (GSV) diameter of those with varicocele (6.6 ±2.3) was significantly larger compared to the mean left GSV diameter of those without varicocele (5.3 ±2.6) (p = 0.004). The area under the ROC curve for left GSV diameter was 67% (p = 0.005). When varicocele screening is performed in patients with a left GSV diameter of 5.35 cm and above, sensitivity is 71.4% and specificity is 61.2%. There is a significant association between left GSV diameter and varicocele (p = 0.004). Varicocele screening can be carried out with 71.4% sensitivity in adult male patients with a left GSV diameter of 5.35 cm and above. Both cardiovascular surgeons and radiologists can conduct varicocele screening by measuring pampiniform veins in patients with a left GSV diameter of 5.35 cm and above. This approach has the potential to reduce the incidence of varicocele and associated infertility.

Evaluation of common femoral vein thickness as a diagnostic tool for Behçet's disease in a non-endemic area.

To evaluate common femoral vein thickness (CFVT) as a diagnostic tool in Brazilian patients with Behçet's disease (BD) and to analyse associations between increased CFVT and disease features. A cross-sectional study was performed including 100 BD patients and 100 controls. The CFVT and the diameters of great saphenous vein (GSV), and small saphenous vein (SSV) were measured by Doppler ultrasound. BD patients had higher right CFVT [0.600mm (0.500-0.700) vs. 0.525mm (0.450-0.637); p=0.012] and left CFVT [0.550mm (0.450-0.650) vs. 0.500mm (0.450-0.550); p=0.004] compared to controls. Vascular involvement of BD and previous deep venous thrombosis were associated with increased CFVT (p<0.05). The number of vascular events correlated with right and left CFVT (Rho = 0.475 p=0.030 and Rho = 0.429 p=0.052, respectively). The 0.575mm cut-off point of right and left CFVT had area under the curve (AUC) of 0.602; 95% confidence interval (95% CI): 0.524-0.680 and AUC: 0.615; 95% CI: 0.537-0.693, respectively. The right and left CFVT had a sensitivity for BD diagnosis of 52% and 43%, and a specificity of 64% and 77%, respectively. No significant differences were found between BD patients and controls regarding the GSV and SSV diameters in both legs (p>0.05). In this study, CFVT measurement was not shown to be a reliable diagnostic test for BD. CFVT was increased in BD patients presenting vascular involvement and correlated with the number of previous events.

Factors influencing recurrent varicose vein formation after radiofrequency thermal ablation for truncal reflux performed in two high-volume venous centers

ObjectiveRecanalization of the saphenous vein trunk after endovenous radiofrequency ablation (RFA) is often associated with recurrent varicose veins (RVVs) or recanalization. This study aimed to assess the long-term results of RFA of the great saphenous vein (GSV) and identify the risk factors for GSV recanalization and RVVs during follow-up for patients presenting to dedicated outpatient vein centers. MethodsAll consecutive patients with incompetent GSVs who underwent RFA between 2009 and 2019 were retrospectively analyzed. The primary study end points were freedom from GSV recanalization and the RVV rate during follow-up. The secondary study end points were the postoperative complication rate and the risk factors for GSV recanalization and RVVs. Univariate and multivariate analyses were performed to identify the potential risk factors for GSV recanalization and RVVs. ResultsDuring the study period, 1568 limbs were treated in 1300 consecutive patients (mean age, 53.5 ± 12.9 years; 71.9% women; CEAP [clinical, etiology, anatomy, pathophysiology] C2-C6; venous clinical severity score >5). Technical success was achieved in 99.7% of cases. At a mean follow-up of 57.2 ± 25.4 months, the GSV occlusion and freedom from reintervention rates were 100% and 100% within 1 week, 97% and 95.7% at 1 year, 95.2% and 93.1% at 3 years, and 92.4% and 92.8% at 5 years, respectively. The recurrence rate was 10% (n = 158) during the follow-up period. On multivariate analysis, a direct confluence of the accessory saphenous vein into the saphenofemoral junction (odds ratio [OR], 1.561; 95% confidence interval [CI], 1.0-7.04; P = .032), a history of pregnancy >2 (OR, 3.68; 95% CI, 1.19-11.36; P = .023), C4 (OR, 6.41; 95% CI, 1.36-30.28; P = .019), and preoperative GSV diameter >10 mm (OR, 1.82; 95% CI, 1.65-4.03; P = .043) were risk factors for GSV recanalization. Moreover, age >70 years (OR, 1.04; 95% CI, 1.01-1.06; P = .014) and incompetent perforator veins (OR, 1.17; 95% CI, 0.65-2.03; P = .018) were also risk factors for RVVs. ConclusionsRFA is a safe technique to ablate the GSV with a low complication rate and durability during 5 years of follow-up. However, patients with a high clinical score and those with direct confluence of the accessory saphenous vein into the saphenofemoral junction experienced higher long-term GSV recanalization and RVV rates.

Determination of Cutoff Diameter of Great Saphenous Vein as Indicative of SaphenoFemoral Junction Incompetence in Cases of Varicose Veins

Abstract Introduction: Saphenofemoral junction (SFJ) incompetence is the most commonly attributed etiological factor in varicose veins of lower limbs with a consequent increase in the caliber of the great saphenous vein (GSV). This study aimed to assess GSV diameter to determine its cutoff diameter value for predicting reflux at the SFJ, in cases of varicose veins. Methods: This hospital-based prospective study was conducted on 156 patients (245 diseased limbs) over a period of 2 years, involving patients referred from the outpatient department for evaluation of varicose veins or those being evaluated as a part of preoperative assessment. Results: The cutoff value of GSV diameter to detect SFJ incompetence was determined at 5.4 mm with best sensitivity of 74.3%, specificity of 78.5%, and accuracy of 75.1%. Conclusion: GSV diameter assessment is of immense clinical importance as it can help the treating physician to filter out the false-negative cases solely being diagnosed based on reflux at SFJ, especially those with an absence of obvious clinical signs.

Effect of obesity on venous blood flow in the lower limbs.

Although obesity is a recognized risk factor for the development of lower limb venous disease, less attention has been paid to objectively measuring the effect of centripetal obesity on blood flow in the lower limbs. The diameter of lower limb veins and venous blood flow were measured in 44 patients (65.6 ±12.5 years, 25 females, 19 males) with centripetal obesity and chronic venous disease. The mean diameter of both common femoral veins (CFV) increased significantly in the semi-supine position following elevation of the panniculus (right: ∆0.73 ±1.21mm; p≤0.001, left: ∆1.16 ±1.42mm; p≤0.001). Moreover, there was a significant increase in venous flow volume in the left CFV (∆62.96 ±117.85ml/min; p = 0.001). Similarly, there was an increase in the diameter of left great saphenous vein (∆0.24 ±0.41mm; p = 0.002), measured at the mid-thigh, when the patient lifted their abdominal panniculus. Finally, the grade of obesity correlated with the extent of the venous disease. These data provide preliminary evidence that centripetal obesity results in both structural and hemodynamic changes in the lower limb veins, even in the absence of classical reflux.

The safest power to be applied in relation to diameter of the vein to give maximal benefit with least complications in endovenous laser ablation of varicose veins

Background Over the years, there have been significant advancements in the treatment of varicose veins. In most surgical settings, the open procedure is still the primary approach. Yet, the popularity of less invasive procedures like EVLA and RFA has produced fantastic outcomes. Objective to assess the safest power of laser which gives maximal effect and least complications in ablation of varicose veins. Methodology A prospective observational study inducing EVLA of different laser power settings (7W &amp; 10W) with preoperative assessment then follow up by CEAP &amp; VCSS and duplex ultrasound measuring great saphenous vein (GSV) diameter and also post-operative complications and time to return to work. Results This study included 50 patients (52 limbs). The Patients were distributed as regard laser power used into two groups (7W, 10W) of 26 limbs for each one. As regard GSV measures changes, there was highly statistically significant decrease in GSV diameter after 1 m and after 3 m compared to preoperative, with P value P&lt;0.001, among patients group. Also, there is higher number of cases with GSV&gt;10 mm in power of laser ‘10w’ group compared to ‘7w; group, with P value (P&lt;0.001); while there is no statistically significant difference between power of laser 7w versus 10w, because all patients ≤10 mm after 1 month and after 3 months, with P value &gt;0.05.Statistically there was no significant difference between 7W &amp; 10W groups as regards time to return to work, CEAP scores and postoperative complications except the significant difference in Pain over the treated vein being less in 7W laser power group. Conclusion For endovenous laser ablation of varicose veins, both 7W and 10W laser power are indicated. They are risk-free and provide the greatest impact with the fewest difficulties for the chosen vein diameter. In our investigation, we came to the conclusion that patients with small GSV diameter required low laser power (7W), while those with large GSV diameter required high laser power (10W).

Customizing foam sclerotherapy of the great saphenous vein: A proposed algorithm to enhance technical efficacy.

The catheter-directed foam sclerotherapy (FS) and the suggested perivenous tumescent application for great saphenous vein (GSV) diameter reduction are suggested to improve technical and clinical results; yet, their use is reported rather indiscriminately. Our aim is to introduce an algorithm categorising the use of technical modalities accompanying ultrasound-guided FS of the GSV and present the technical efficacy of FS through a 5 F × 11 cm sheath placed at the knee level. Representative cases of GSV insufficiency were chosen to describe our methodology. Sole sheath-directed FS can achieve complete GSV occlusion proximally at a level comparable to the catheter-directed technique. We apply perivenous 4°C cold tumescent to GSV >6mm even in the standing position to ensure diameter reduction of the proximal GSV as close to the saphenofemoral junction. We use long catheters only to overcome large varicosities above the knee level that could otherwise compromise the adequate foam infusion from the sheath tip. When GSV insufficiency extends along the entire limb and severe skin lesions preclude the antegrade distal catheterisation, the sheath-directed FS in the thigh can be concomitantly combined with retrograde FS from catheterisation just below the knee. A topology-oriented methodology with sheath-directed FS is technically feasible and avoids indiscriminate use of more complex modalities.

Are all patients with sapheno-femoral junction incompetence the same? An ultrasound analysis to potentially predict recurrence after invasive treatments

The sapheno-femoral junction (SFJ) and the great saphenous vein (GSV) are recognized as one of the main sources of reflux in chronic venous disease. Moreover, reflux time is considered as the main parameter to characterize GSV disease. Despite this, it is well-known in the clinical practice that not all patients with SFJ/GSV reflux are similar, in terms of disease severity and degree. Some other anatomical findings, such as SFJ and GSV diameters, as well as the absence/incompetence of suprasaphenic femoral valve (SFV) might be of interest to better "quantify" the disease severity. The aim of this paper is to describe, through a duplex scan analysis, the relationship between SFJ incompetence, GSV/SFJ diameter and SFV absence/incompetence, to identify if there are patients with "severe" GSV disease and a potential higher recurrence rate after invasive treatments.

Assessment of Relationship between Saphenofemoral Junction Reflux and Great Saphenous Vein Diameter using Doppler Ultrasonography in Patients with Chronic Venous Disease: A Cross-sectional Study

Introduction: Chronic venous disease is a commonly occurring disease that includes a variety of pathological conditions like varicose veins, oedema, skin abnormalities, and ulceration, among which the most prevalent are the varicose veins. Doppler imaging is presently the first investigation for evaluating chronic venous disease. Aim: To investigate the relationship between Saphenofemoral Junction (SFJ) reflux and Great Saphenous Vein (GSV) diameter in patients with chronic venous disease and to determine the best cut-off value of GSV diameter in predicting reflux. Materials and Methods: The present cross-sectional study was conducted in the Department of Radiology, SRM Medical College and Hospital, Tamil Nadu, India, from December 2019 to June 2021 on 76 patients with chronic venous disease. The study was conducted on a GE Logic P9 ultrasound machine, the diameter of GSV was measured close to the SFJ, at the Proximal Thigh (PT); 15cm distal to the SFJ, and at the calf. The diameter of the GSV was compared with the presence of SFJ reflux. Similarly, Short Saphenous Vein (SSV) diameter was also measured posterior to the knee and was correlated with Saphenopopliteal Junction (SPJ) reflux. Chi-square and student t-tests were used for analysis with a cut-off value determined through Receiver Operating Characteristic (ROC) curve analysis. Results: The mean age of study participants was 51±15.85 years with age range of 19 years to 78 years. Of total, 42 (55.26%) had chronic venous insufficiency on the left side and 34 (44.74%) had on the right side. The mean GSV diameter at SFJ and at PT was higher in patients with SFJ incompetence and was statistically significant with a p-value of 0.001 and 0.002, respectively by t-test. Although the mean GSV diameter at calf was higher in patients with SFJ incompetence, it was statistically insignificant. The GSV diameter at the SFJ had the best cut-off value for predicting incompetence, with a mean diameter of 5.95 mm with 76.3% sensitivity and 76.3% specificity. The cut-off of SSV at the posterior knee for predicting SPJ incompetence was 4.6 mm which had a sensitivity of 72.7% and specificity of 88.7% and diagnostic accuracy of 86.84%. Conclusion: The GSV diameter at SFJ and PT help in predicting SFJ incompetence. The SSV diameter at SPJ aids in predicting SPJ incompetence.

Randomized controlled trial comparing immediate and delayed treatment of varicose veins following mechanochemical ablation

ObjectiveThe standard treatment of superficial venous insufficiency consists of endovenous thermal ablation of the refluxing main trunk, combined with side branch treatment, if needed. Side branches are often treated with phlebectomy concurrently or as a staged procedure. Whether the delayed treatment is justifiable, taking into consideration the long-term outcomes of the treatment and the need for later interventions, remains an open question. The objective of this study is to evaluate the necessity of immediate treatment of varicosities and to compare it with delayed treatment after mechanochemical ablation of the main trunk of the great saphenous vein (GSV). MethodsVenous outpatient clinic patients with varicosities (clinical classification C2-C4) resulting from GSV insufficiency were randomized to receive mechanochemical ablation only or mechanochemical ablation with concurrent phlebectomies at a ratio of 1:1. After eligibility assessment of 1149 patients, 85 met the inclusion criteria, which were age 20 to 70 years, ultrasound-verified GSV insufficiency, mean GSV diameter of 5 to 10 mm in the thigh, and provision of written informed consent. The exclusion criteria were deep venous reflux, peripheral arterial disease, pregnancy, lymphedema, body mass index of >40 kg/m2, an allergy to the sclerosant, a history of deep vein thrombosis, and/or any form of coagulopathy. The primary outcome was the need for sclerotherapy at 3 months after treatment. The secondary outcome measures, which were assessed at 3 months and 1 year, were complications, duration of sick leave, overall patient satisfaction, and GSV occlusion rate. ResultsAt 3 months, 13.2% of the patients randomized to delayed treatment needed sclerotherapy. No statistically significant difference was found in the occlusion rate of the GSV at either 3 months (mechanochemical ablation only group, 94.7%; mechanochemical ablation with phlebectomy group, 100%; P = 1.000) or 1 year (mechanochemical ablation only group, 89.7%; mechanochemical ablation with phlebectomy group, 94.4%; P = 1.000). The groups were also similar in terms of disease-specific quality of life (P = .964), health-related quality of life (P = .337), and the other outcome measures within the study period. ConclusionsThe need for reintervention did not increase and the patients' quality of life and satisfaction with the procedure were similar at 1 year when mechanochemical ablation only was compared with mechanochemical ablation plus phlebectomy.

The Cut-off Value of Great Saphenous Vein Diameter at the Level of Femoral Condyle to Predict the Sapheno-Femoral Junction Incompetence

Background Varicose vein is one of the commonest problems that patients visit to a vascular out patient services (OPD). It causes a great deal of morbidity in today’s population.&#x0D; Objective To see the correlation between the size of great saphenous and Saphenofemoral junction incompetence.&#x0D; Method From January 2019 till January 2020, 396 patients with symptomatic or clinically diagnosed varicose veins were screened for Saphenofemoral junction reflux. The diameter of the saphenous vein was measured with B-mode imaging, and reflux was quantified based on valve closure time using Doppler spectral measurements. Best saphenous vein diameter cutoff for predicting reflux was determined using receiver operating characteristics curve analysis.&#x0D; Result Out of 792 limbs, the Great Saphenous Venous System was involved in 452 limbs, the Short Saphenous Venous System was involved in 151 limbs and significant perforators were present in 240 limbs. Mean great Saphenous Vein diameter of diseased limb (Reflux Positive) was 5.68 mm and 4.0 mm in control group (Reflux Negative). Mean Saphenofemoral junction diameter was 8.23 mm in diseased limbs and 6.16 mm in control limbs. Receiver operating characteristics curve showed great saphenous vein diameter at femoral condyle of 4.5 mm as best cut-off value for diagnosis of sapheno femoral junction reflux.&#x0D; Conclusion Great Saphenous Vein diameter at femoral condyle of 4.5 mm is the best cut-off value for diagnosis Saphenofemoral junction reflux. The Sensitivity and specificity of this cut off value is 81.8% and 71% respectively.

Thigh-length graduated compression stocking cannot increase blood velocity of the common femoral vein in patients awaiting total hip arthroplasty

ObjectivesGraduated compression stocking (GCS) is one of the mechanical prophylaxes commonly used for deep vein thrombosis (DVT). The present study was designed to observe the effects of graduated compression stockings on the vein deformation and hemodynamics of lower limbs in patients awaiting total hip arthroplasty (THA).MethodsThe lower extremity veins of 22 patients awaiting THA were examined by ultrasound, when they rested in supine position with or without thigh-length GCS. The deformation parameters we measured included antero-posterior (AP) diameters, latero-medial (LM) diameters, and cross-sectional area (CSA) of great saphenous vein (GSV), posterior tibial vein (PTV), popliteal vein (PV), gastrocnemius vein (GV), and superficial femoral vein (SFV). We measured peak velocity and mean velocity of GSV, common femoral vein (CFV), junction of GSV and CFV to represent for hemodynamics of veins.ResultsSignificant compression was observed in almost all measured veins with the use of thigh-length GCS, while it was unable to significantly compress GSV in latero-medial diameter. The mean latero-medial diameter reductions for GSV, PTV, GV, PV and SFV were 19.4, 30.2, 43.2, 29.7 and 20.4%, respectively. GCS significantly compressed antero-posterior diameter of GSV, PTV, GV, PV and SFV by 43.4, 33.3, 42.1, 37.5, and 27.8%, respectively. The mean reduction of cross-section area was 44.8% for GSV, 49.6% for PTV, 60.0% for GV, 57.4% for PV, and 36.2% for FV. No significant changes were observed in the mean blood velocity of GSV, CFV, and junction. GCS was able to significantly reduce peak velocity of CFV (17.6 ± 5.6 cm/s to 16.1 ± 6.0 cm/s) and junction (23.3 ± 9.5 cm/s to 21.3 ± 9.7 cm/s), while it did not change the peak velocity of GSV.ConclusionThigh-length GCS is sufficient to compress lower extremity veins in patients awaiting THA in supine position with the greatest compression in GV, while it was unable to significantly increase blood velocity of common femoral vein or GSV. GCS may prevent DVT through more than simply increasing blood flow. Further studies are needed to determine the specific effects of GCS.

Increased Great Saphenous Vein Diameter at the Level of Knee among Patients with Varicose Veins in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Colour Doppler ultrasonography plays an important role in determining the morphological and hemodynamic information of the venous system. This study aimed to find out the prevalence of increased great saphenous vein diameter at the level of the knee among patients with varicose veins in a tertiary care centre. A descriptive cross-sectional study was carried out in the Department of Radiology at a tertiary care centre from 30 October 2021 to 31 March 2022 after taking ethical approval from the Institutional Review Committee (Reference number: 028-077/078). A convenience sampling technique was used for the study. The study group consisted of patients over 18 years, coming for ultrasonography examination of the lower limb with the clinical symptoms and signs of varicose veins. The great saphenous vein diameter was measured at the level of the medial femoral condyle of the knee using the software in the ultrasonography unit. B mode, colour Doppler and spectral analysis were done. A cut-off value of 5 mm for the diameter of the great saphenous vein was taken to indicate the presence or absence of varicosity and saphenofemoral reflux. Point estimate and 90% Confidence Interval were calculated. Among 72 patients with varicose veins, the diameter of the great saphenous vein was increased in 59 (81.94%) (74.50-89.38, 90% Confidence Interval) patients. The mean diameter of the great saphenous vein in our study was similar when compared to other studies conducted in similar settings. saphenous vein; ultrasonography; varicose veins.

Comparison of long occlusive femoropopliteal de novo versus previous endovascularly treated lesions managed with in situ saphenous bypass

BackgroundThe aim of this study was to compare the 2-year outcomes of de novo versus postendovascular lesion treatment of femoropopliteal occlusions included in a national, multicenter, observational, prospective registry based on the treatment of critical Limb-threatening IschaeMia with infragenicular Bypass adopting in situ SAphenous VEin technique (LIMBSAVE) registry. MethodsFrom January 2018 to December 2019, 541 patients from 43 centers have been enrolled in the LIMBSAVE registry. Of these patients, 460 were included in the present study: 341 (74.1%) with de novo lesions (DN group) and 119 (25.9%) with postendovascular treatment lesions (PE group). Initial outcome measures were assessed at 30 days after treatment. Furthermore, at the 2-year follow-up, the estimated outcomes of primary patency, primary-assisted patency, secondary patency, and limb salvage were analyzed with Kaplan-Meier curves and compared between groups with the log-rank test. ResultsBoth groups were homogeneous in terms of demographic data, preoperative risk factors, and clinical presentation. However, compared with DN group, more patients in PE group had a great saphenous vein diameter of less than 3 mm (11.1% vs 21%; P = .007). Intraoperatively, both groups showed similar distal anastomosis sites: below-the-knee popliteal artery (63% DN group, 66.4% PE group) and tibial vessel (37% DN group, 33.6% PE group) (P = .3). The overall mean duration of follow-up was 11.6 months (range, 1-24 months). At the 2-year follow-up, there were no differences between the two groups in terms of primary patency (66.3% DN group vs 74.1% PE group; P = .9), primary-assisted patency (78.2% DN group vs 79.5% PE group; P = .2), secondary patency (85.1% DN group vs 91.4% PE group; P = .2), and limb salvage (95.2% DN group vs 95.1% PE group; P = .9). ConclusionsThe LIMBSAVE registry did not show a worsening of overall patency and limb salvages rates at the 2-year follow-up in patients undergoing in situ saphenous bypass after a failed endovascular approach for long femoropopliteal occlusive disease. This finding is in contrast with what has been published in literature.

Diameter-reflux relationship of the saphenous vein in the C0-C3 patients of chronic venous disease.

To evaluate the relationship between the saphenous vein's diameter and reflux and determine the cut point of the saphenous vein's diameter that indicates lack of reflux. A retrospective cohort study conducted in 807 limbs underwent the venous ultrasound for 36months. The saphenous vein's diameter in the reflux and non-reflux groups was evaluated. The receiver operating characteristics (ROC) curve was constructed to determine the saphenous vein's diameter that maximizes the summation of sensitivity and specificity for saphenous vein reflux in C0-C3 patients. The reflux group had a significantly greater diameter than a non-reflux group at four great saphenous vein (GSV) levels and two small saphenous vein (SSV) levels (p-value < 0.001). The venous reflux correlated significantly with GSV diameter at all four GSV levels and two SSV levels (p-value <0.001). The ROC area of the diameter at four GSV levels ranges from 0.59 to 0.69. The optimal cut-off diameter for GSV reflux is 3.8mm at the proximal thigh, 2.8mm at the distal thigh, 3.2mm at the proximal calf, and 2.5mm at the distal calf. The ROC area of the diameter at two SSV levels ranges from 0.66 to 0.67. The optimal cut-off diameter for SSV reflux is 2.5mm at the proximal calf and 2.3mm at the distal calf. The saphenous vein's diameter has been proved to be significantly correlated with the presence of reflux in duplex ultrasound in all lower limbs' levels. Unfortunately, the study's cut point diameter is considered poor accuracy and is not an accurate measurement to use as the screening test for the presence of reflux.

The CHIVA strategy applied to large-diameter saphenous veins.

CHIVA (Cure Conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire) is a conservative outpatient treatment strategy for chronic venous disease (CVD) that preserves the superficial venous system. A modified two-stage strategy is used in patients with a great saphenous vein (GSV) diameter ≥9 mm with the goal to decrease the risk of symptomatic superficial vein thrombosis (SVT), as the risk of complications is higher when first and second stage is performed simultaneously. We conducted a retrospective observational study of 111 patients with CVD and a GVS diameter ≥9 mm treated with two possible stages of the CHIVA strategy, between January 2010 and December 2019. The goal of the first stage was to interrupt the main reflux escape point (incompetent saphenofemoral junction), thereby lowering the venous pressure and achieving a sufficient reduction in GSV diameter to enable, if necessary, a second stage that consists of disconnection of secondary reflux exit point (incompetent saphenous tributaries), with a lower risk of symptomatic SVT when patients do not show significant clinical improvement. Reductions in GSV diameter, postoperative complications and clinical improvement were analyzed. There were 60 men (54.1%) and 51 women (45.9%) with a mean age of 57±11.9 years. All patients undergone first surgical stage, and this interruption of the saphenofemoral junction was the single procedure in 77.5% of cases (86 patients). Mean follow-up time was 19.8 months. The second stage was performed in 25 patients (22.5%). Mean preoperative GSV diameter was 10.2±1.1 mm and this decreased to 7.1±1.5 mm after the first surgery (mean reduction, 3±1.5 mm, P<0.001). Six patients (5.4%) experienced recurrence due to recanalization of the reflux point and 16 patients (14.4%) developed SVT, which was symptomatic in 12 cases (10.8%). Interruption of the main reflux escape point as a single procedure in patients with a GSV diameter ≥9 mm led to a significant reduction in diameter and sufficient clinical improvement in almost 80% of cases.

Modification of protocol with one extra drop of endovascular cyanoacrylate improved closure rates in incompetent great saphenous veins.

Great saphenous vein diameter (GSV) of >8mm was predictor of recanalization following Venaseal cyanoacrylate treatment. The aim of this study was to report our modified protocol with a single extra-drop for treatment for GSV>8mm, and comparative duplex results in closure rates. Patients in our single-centre registry treated with Venaseal were followed up by serial duplex examinations at week 1 and month(s)- 1, 6, 12, 18, 24, and then annually. The primary endpoint was successful obliteration of the GSV, secondary endpoints were closure distance from Saphenofemoral junction (SFJ), presence of endovenous glue-induced thrombosis (EGIT) or deep vein thrombosis. A total of 243 legs in 123 consecutive patients with duplex-proven SFJ/GSV incompetence were included in this study between September 2014 and October 2020. The median duplex follow-up period of this cohort of patients was 24 (range 0.2-58) months. Comparing closure rates in GSV diameter ≥8mm treated with normal protocol, the 'extra-drop protocol' significantly improved closure rates (p = .034). However, the closure rates of ≥8mm GSV treated with 'extra-drop protocol' was still not as good as GSV <8mm (p < .001). There were no statistically significant differences in the stump distance between the three groups and no difference in the occurrence of EGIT. There were no deep vein thrombosis. Our experience showed that VenaSeal cyanoacrylate worked best in GSV<8mm diameter. Even in GSV diameter of ≥8mm which has a higher recanalization rate on follow-up duplex, our modified extra-drop protocol significantly improved the closure rates, and did not predispose to development of EGIT.

The multimodal treatment approaches to varicose veins: Preservation versus thermal ablation of the incompetent great saphenous vein

Objective: To compare the clinical efficacy of Ambulatory Selective Varices Ablation under Local Anesthesia (ASVAL) and Endovenous Laser Ablation (EVLA) with concomitant phlebectomy in patients with the incompetent Great Saphenous Vein (GSV). Design: “Prospective Case Series study (C2-C3 patients) with 2 and 5 years follow-up. Methods: This was a prospective observational cohort study in a single center. Seventy-six patients (59 females) with GSV incompetence and C2-C3 were included in the prospective consecutive case study. The diameter of GSV at the 15-cm below the SFJ level was the main criterion to identify two groups of patients. Thirty-three patients (25 females, mean age 37.03) with the GSV diameter ≤6 mm were treated with ASVAL. Forty-three patients (34 females, mean age 46.19) with the GSV diameter &gt;6 mm were treated by EVLA with concomitant phlebectomy. Clinical and functional outcomes measured by Venous Clinical Severity Score (VCSS) and clinical recurrence-free rate according to the classification of recurrent varicose veins after treatment (PREVAIT) were analyzed in 2 years follow-up. The clinical recurrence-free rate was analyzed in 5 years follow-up. Results: 2-year follow-up was detected a significant decrease in the postoperative VCSS in the ASVAL and the EVLA group (p&lt; 0.001). There was no statistically significant difference between both groups in VCCS in 2 years post-operation (p= 0.681). Frequency of recurrence did not differ between ASVAL (18.8%) and EVLA (21.4%) groups 2 years after treatment (p= 0.776) and the diameter of the GSV significantly decreased in the ASVAL group (5.48 vs 5.13, p= 0.008). The 5-year follow-up was detected recurrences in 40.0% of patients ASVAL group and 45.6% EVLA group (p = 0.668). Conclusions: Both ASVAL and EVLA effectively improve the disease severity in the groups of patients, selected according to the GSV diameter (≤ 6 mm or &gt; 6 mm).