Length Of Great Saphenous Vein Research Articles

Correlation between great saphenous length of treatment zone and diameter with improvement in symptoms after ablation

ObjectiveThe aim of the present study was to examine the relationship between the great saphenous vein (GSV) length of segment ablated and diameter with symptom improvement. MethodsData from a multicenter, randomized, controlled prospective study of 242 patients undergoing radiofrequency ablation (RFA) or cyanoacrylate closure (CAC) of the GSV were analyzed. The venous clinical severity score (VCSS) was measured at baseline and at 1, 3, 6, 12, 24, and 36 months after ablation. The GSV diameter was evaluated for a correlation with VCSS at each time point. Using the median treatment length of 34 cm, the patients were divided into group I (treatment length ≥34 cm) vs group II (<34 cm) for analysis. The pretreatment VCSS and VCSS improvement (ΔVCSS) after treatment were evaluated with respect to the length of the ablated GSV segment. The postablation VCSS was compared between the pretreatment GSV diameters of <5.5 mm vs ≥5.5 mm. ResultsThe mean GSV length ablated by RFA was 35.3 ± 14 cm vs 32.6 ± 11 cm with CAC (P = NS). No significant difference was found in the VCSS (at baseline or follow-up) between RFA and CAC. The pooled data for all participants (n = 242) demonstrated a correlation between the treated GSV length and pretreatment VCSS and the ΔVCSS at 36 months (R = 0.23; P < .001). Greater VCSS improvement was seen in group I (≥34 cm ablated) than in group II (<34 cm ablated) at ≤36 months of follow-up (P = .003). At baseline, group I had had higher VCSSs (6.21 ± 2.75 vs 4.88 ± 2.33; P < .00001) and CEAP (clinical, etiologic, anatomic, pathophysiologic) and reflux scores. Of the 242 patients, 101 had had a GSV diameter <5.5 mm and 141 had had a GSV diameter of ≥5.5 mm. No significant differences were noted in the VCSSs, either at baseline or at follow-up, between the two groups. Within the study population, a poor correlation was found between the GSV diameter and baseline VCSS (R = −0.004; P = .95) and between the GSV diameter and ΔVCSS for ≤36 months (R = 0.04; P = .55). ConclusionsLonger segments of GSV reflux appeared to correlate with symptom severity. We found a small to moderate correlation between the length of GSV segment ablated and symptom improvement. This might reflect the greater severity of symptoms at baseline in patients with longer segments with reflux. We found a poor correlation between the proximal GSV diameter and symptom improvement after ablation.

Anatomy of Fascial Canal of Great Saphenous Vein: An Observational Study

Introduction: The fascial canal for great saphenous vein has a variable presence throughout the course of the vein. The anatomy of great saphenous vein and its tributary becomes complicated owing to interruptions and variability of the saphenous fascia around the knee compared with the upper portion of thigh and lower portion of leg. It has been observed that vein not enclosed in saphenous fascial canal is prone to have dilatations which can lead to varicosity of the vein. Aim: To study the length and extent of fascia of great saphenous vein in 10 male and five female cadavers by macroscopic and microscopic observation. And also to note the length of great saphenous vein in thigh and leg. Materials and Methods: An observational cadaveric study was done in which 10 male and five female cadavers were obtained and superficial dissection was performed in order to expose the Great Saphenous Vein (GSV) and its fascia. The lower limb was divided into eight equal quadrants and sample was taken from each quadrant for microscopic examination to confirm presence of saphenous fascia. Results: In present study, there was absence of fascia in 30 lower limb (13.33%) in whole length of great saphenous vein. There was no case in which the fascia extended throughout the length of great saphenous vein. No fascial canal was found in the lowermost quarter of leg. Conclusion: Knowledge of the presence of saphenous fascia is essential while performing endovenous ablation. The utility of compression therapy and extent of compression needed may vary depending upon the presence or absence of saphenous fascia around great saphenous vein.

Evaluation of radiofrequency ablation for primary varicose veins: A preliminary study

Background: Endovenous radiofrequency ablation is gaining popularity as an alternative to conventional surgical treatment of varicose veins. The initial experience with this treatment modality is presented along with review of literature. Methods: A prospective study of 31 consecutive patients with primary great saphenous vein varicosities was undertaken. The procedure was performed under spinal anesthesia using bipolar radiofrequency induced thermotherapy CELON (Olympus) system with continuous pull-back technique. Additionally, multiple stab phlebectomies were performed to deal with tributary varices. Post-operatively; at one, four, twelve and twenty four weeks, the patients were followed up in out-patient department with clinical examination and ultrasound duplex imaging. The occlusion of great saphenous vein trunk, length of residual patent proximal great saphenous vein and improvement in quality of life using revised Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire were recorded and analysed using appropriate statistical methods. Results: The mean (SD) age of patients was 41.8 (14.1) years with an average BMI of 23.4 kg/m2. Ten patients had C2 disease, four C3, thirteen C4, and two each; C5 and C6 disease. Average length of great saphenous vein ablated was 41.9 cm with a mean ablation time of 62.3 (18.6) seconds. Post procedure total occlusion rate at 24 weeks follow-up, was 93.1% and the quality of life indices showed a statistically significant improvement. Conclusion: Endovenous radiofrequency ablation holds immense promise as a safe and effective modality for the treatment of varicose veins of lower limbs.

Great saphenous vein reflux treatment in patients with femoral valve incompetence, the Excluded Saphenous Vein Technique (ESVT): a pilot study.

To describe and evaluate feasibility and efficacy of a saphenous ablation technique performed in patients with varicose veins (VVs), great saphenous vein (GSV) incompetence, and proximal femoral valve incompetence: the Excluded Saphenous Vein Technique (ESVT). Patients with primary great saphenous and proximal femoral valve incompetence underwent ESVT. This technique is composed of selective crossectomy, GSV ligation next to the thigh incompetent tributary vein, and saphenous vein sclerosing performed from the proximal zone. Demographic, clinical and instrumental data were collected. CEAP classification was used to describe VVs severity. The primary outcome was perioperative complications. Secondary outcomes were 30-days, 6-months and 1-years GSV occlusion rate, and VVs recurrence rate. During a ten months period, 104 patients were analyzed. Among these, 82 patients underwent ESVT (59 female, age 50 ± 21 years), eighty C2 and two C5, according to CEAP classification. The average length of GSV treated was 23 ± 9 cm. No intraoperative complications occurred. A 1-year follow-up analysis revealed no partial or complete saphenous recanalization, deep venous thrombosis, pulmonary embolism. No VVs recurrence was detected during the follow-up period among the entire population. ESVT seems to be a safe and effective treatment for primary saphenous reflux and proximal femoral valve incompetence. Further studies are needed to assess long-term results.

Predictors of Recanalization for Incompetent Great Saphenous Veins Treated With Cyanoacrylate Glue

Abstract Purpose To determine predictors of recanalization in patients treated with endovenous cyanoacrylate. Methods Follow-up by serial clinical and duplex examinations was performed at 1 week, 1 month, 6 months, 12 months, and 24 months of 108 legs in 55 patients (21 men, median age 65 y) with primary varicose veins treated with endovenous cyanoacrylate. Cox regression analysis was used to examine venous characteristics before the procedure: diameter of great saphenous vein (GSV), treatment length of GSV, presence of incompetent perforators, clinical severity of varicose vein, and experience of operator as predictors of recanalization. With the patient in supine position, GSV diameter was measured at 3 levels (proximal thigh 1 cm from saphenofemoral junction, midthigh, and distal thigh above knee). Results Of 108 legs, 2 had minimal extension of thrombus to deep vein, and 4 had superficial thrombophlebitis. Kaplan-Meier analysis showed GSV closure rates were 97.2%, 92.3%, 89.2%, and 75.7% at 1 week, 1 month, 6 months, and 12 months after the procedure. With a median follow-up period of 5 months (range, 0–18 months), 4 legs had clinical recurrence. Mean GSV diameter ≥ 6.6 mm was the only significant predictor for recanalization (hazard ratio 12.1; 95% CI, 1.6–92.7; P = .016). Conclusions The use of endovenous cyanoacrylate to treat varicose veins caused by incompetent GSV was safe. GSVs

Predictors of Recanalization for Incompetent Great Saphenous Veins Treated with Cyanoacrylate Glue

PurposeTo determine predictors of recanalization in patients treated with endovenous cyanoacrylate. MethodsFollow-up by serial clinical and duplex examinations was performed at 1 week, 1 month, 6 months, 12 months, and 24 months of 108 legs in 55 patients (21 men, median age 65 y) with primary varicose veins treated with endovenous cyanoacrylate. Cox regression analysis was used to examine venous characteristics before the procedure: diameter of great saphenous vein (GSV), treatment length of GSV, presence of incompetent perforators, clinical severity of varicose vein, and experience of operator as predictors of recanalization. With the patient in supine position, GSV diameter was measured at 3 levels (proximal thigh 1 cm from saphenofemoral junction, midthigh, and distal thigh above knee). ResultsOf 108 legs, 2 had minimal extension of thrombus to deep vein, and 4 had superficial thrombophlebitis. Kaplan-Meier analysis showed GSV closure rates were 97.2%, 92.3%, 89.2%, and 75.7% at 1 week, 1 month, 6 months, and 12 months after the procedure. With a median follow-up period of 5 months (range, 0–18 months), 4 legs had clinical recurrence. Mean GSV diameter ≥ 6.6 mm was the only significant predictor for recanalization (hazard ratio 12.1; 95% CI, 1.6–92.7; P = .016). ConclusionsThe use of endovenous cyanoacrylate to treat varicose veins caused by incompetent GSV was safe. GSVs < 6.6 mm in diameter had a closure rate of 90.0% at 12 months. Despite 97.2% closure rates at 1 week, recanalization was observed in GSVs with larger diameter.

Reflux in the below-knee great saphenous vein can be safely treated with endovenous ablation

Intervention on the great saphenous vein (GSV) has traditionally been limited to the above-knee (AK-GSV) segment for fear of saphenous neuralgia in spite of incompetence demonstrated in the below-knee (BK-GSV) segment. Residual symptoms and need for reintervention are reported to result in nearly half the patients if the refluxing BK-GSV is ignored. Experience with endovenous ablation of the BK-GSV at the time of AK-GSV treatment is sparsely reported in the literature. The aim of this study was to evaluate the safety of endovenous ablation of the refluxing BK-GSV. Data from consecutive patients treated with superficial venous ablation during a 48-month period from January 2010 to December 2013 were retrospectively reviewed. Demographic and procedure-related outcome and complication data were analyzed specifically for patients undergoing BK-GSV interventions. A total of 550 patients were treated with superficial venous ablation during the study period. Of those, 61 (79 limbs) underwent BK-GSV ablation for reflux at this site. There were 36 women and 25 men (mean age, 55years). Median Clinical, Etiologic, Anatomic, and Pathologic (CEAP) score was 3.4; 43 limbs were treated for symptomatic varicose veins (C 1-3) and 36 for advanced venous insufficiency (C 4-6); 14 limbs (18%) were treated for recurrent symptomatic varicose veins or venous insufficiency after prior superficial venous intervention with AK-GSV ablation, sclerotherapy, or stripping. Comorbidities included obesity (54%) with mean body mass index of 30.7 (range, 19 to 52), obstructive sleep apnea (10%), pulmonary hypertension (3%), and congestive heart failure (3%). Ablation was performed in 77 limbs (99%)with the VenaCure EVLT laser vein treatment (AngioDynamics, Queensbury, NY) and in two limbs by radiofrequency ablation with ClosureFAST system (VNUS Medical Technologies, San Jose, Calif). The mean length of GSV ablated was 51.2cm (range, 26-67cm). Endovenous ablation was performed concomitantly on 22 accessory GSVs (28%) and 10 incompetent perforators (13%). Ambulatory stab phlebectomy of branch varicosities was performed simultaneously in 59 limbs (75%). All veins treated were evaluated with ultrasound on postprocedure day 1, and no evidence of endovenous heat-induced thrombosis was detected. Eight patients (10%) went on to have preplanned sclerotherapy treatment for small-branch varicosities. Postoperative paresthesia occurred in three patients (4%) and resolved within 4weeks. Wound infection in three (4%) stab phlebectomy wounds resolved with oral antibiotic therapy. Follow-up surveillance ultrasound was available in 32 of 79 limbs that were >6months from the procedure. Partial late recanalization was noted in four of 32 limbs, but no patient had recurrent symptoms requiring repeated endovenous ablation during this period. Endovenous ablation of the refluxing BK-GSV segment can be performed safely with minimal complications. Consideration should be given to concomitant ablation of the BK-GSV in treatment of patients with varicose veins with reflux extending to the BK segment of the GSV to improve long-term outcomes.

Endovenous laser with miniphlebectomy for treatment of varicose veins and effect of different levels of laser energy on recanalization. A single center experience.

Varicose veins, associated with great saphenous vein (GSV) incompetence, are traditionally treated with conventional surgery. In recent years, minimally invasive alternatives to surgical treatment such as the endovenous laser ablation (EVLA) and radiofrequency (RF) ablation have been developed with promising results. Residual varicose veins following EVLA, regress untouched, or phlebectomy or foam sclerotherapy can be concomitantly performed. The aim of the present study was to investigate the safety and efficacy of EVLA with different levels of laser energy in patients with varicose veins secondary to saphenous vein reflux. From February 2006 to August 2011, 740 EVLA, usually with concomitant miniphlebectomies, were performed in 552 patients. A total of 665 GSV, 53 small saphenous veins (SSV), and 22 both GSV and SSV were treated with EVLA under duplex USG. At 84 patients, bilateral intervention is made. In addition, miniphlebectomy was performed in 540 patients. A duplex ultrasound (US) is performed to patients preoccupying chronic venous insufficiency (with visible varicose veins, ankle edema, skin changes, or ulcer). Saphenous vein incompetence was diagnosed with saphenofemoral, saphenopopliteal, or truncal vein reflux in response to manual compression and release with patient standing. The procedures were performed under local anesthesia with light sedation or spinal anesthesia. Endovenous 980-nm diode laser source was used at a continuous mode. The mean energy applied per length of GSV during the treatment was 77.5 ± 17.0 J (range 60-100 J/cm). An US evaluation was performed at first week of the procedure. Follow-up evaluation and duplex US scanning were performed at 1 and 6 months, and at 1 and 2 years to assess treatment efficacy and adverse reactions. Average follow-up period was 32 ± 4 months (3-55 months). There were one patient with infection and two patients with thrombus extension into the femoral vein after EVLA. Overall occlusion rate was 95%. No post-procedural deep venous thrombosis or pulmonary embolism occurred. Laser energy, less than 80 J/cm, was significantly associated with increased recanalization of saphenous vein, among the other energy levels. EVLA seems a good alternative to surgery by the application of energy of not less than 80 J/cm. It is both safe and effective. It is a well-tolerated procedure with rare and relatively minor complications.

Reflux in the Below-knee Great Saphenous Vein Can Be Safely Treated with Endovenous Ablation.

Intervention on the great saphenous vein (GSV) has traditionally been limited to the above-knee (AK-GSV) segment for fear of saphenous neuralgia, in spite of incompetence demonstrated in the below-knee (BK-GSV) segment. Ignoring the refluxing BK-GSV is reported to result in residual symptoms and need for re-intervention in nearly half the patients. Experience with endovenous ablation of the BK-GSV at the time of AK-GSV treatment is sparsely reported in the literature. The aim of this study is to evaluate the safety of endovenous ablation of the refluxing BK-GSV. Data from consecutive patients treated with superficial venous ablation over a 30-month period from January 2010 until August 2012 were retrospectively reviewed. Demographic and procedure-related outcome and complication data were analyzed specifically for patients undergoing BK-GSV interventions. A total 387 patients were treated with superficial venous ablation during the study period. Of those, 38 (47 limbs) underwent BK- GSV ablation for reflux at this site. There were 22 females and 16 males (mean age, 51 years). Median CEAP score was 3; 27 limbs were treated for symptomatic varicose veins (C 1-3) and 20 for advanced venous insufficiency (C 4-6). Five (10.6%) limbs were treated following prior failed intervention with AK-GSV ablation, sclerotherapy, or stripping. Comorbidities included obesity (41.7%) with mean body mass index of 31.4 (range, 19 to 52), obstructive sleep apnea (13.2%), pulmonary hypertension (2.6%), and congestive heart failure (2.6%). Ablation was performed in 45 limbs (97%), utilizing the VenaCure EVLT laser vein treatment (AngioDynamics, Queensbury, NY) and two limbs using RFA (radiofrequency ablation) with ClosureFAST system (VNUS Medical Technologies, San Jose, CA) . Mean GSV length ablated was 51.6 cm (range, 26 to 65 cm). Endovenous ablation was performed concomitantly on 18 accessory GSVs (38.3%) and 4 incompetent perforators (8.5%). Ambulatory stab phlebectomy of branch varicosities was performed simultaneously in 37 (79%) limbs. All veins treated were evaluated with ultrasound on post procedure day 1, and no evidence of endovenous heat induced thrombosis (EHIT) was detected. Seven patients (14.9%) went on to have preplanned sclerotherapy treatment for small branch varicosities. Postoperative hyperesthesia occurred in one patient (2.1%) and resolved within 2 weeks. No patient required repeat endovenous ablation during this period. Wound infection in two (4.3%) stab phlebectomy wounds resolved with oral antibiotic therapy. Endovenous ablation of the refluxing BK-GSV segment can be performed safely with minimal complications. Consideration should be given to concomitant ablation of the BK-GSV when treating patients with varicose veins with reflux extending below the knee to improve long-term outcomes.

Great saphenous vein patency and endovenous heat-induced thrombosis after endovenous thermal ablation with modified catheter tip positioning

Thrombus extension into a deep vein after superficial venous thermoablation remains a unique complication in the treatment of superficial reflux disease of the great saphenous vein (GSV). In this study, we evaluate if catheter tip positioning or vein diameter correlate with the length of proximal patent segment of GSV after ablation and more caudal catheter positioning decreases the incidence of proximal thrombus extension into the femoral vein. This was a prospective study conducted from January 2008 to November 2009 of 73 patients undergoing radiofrequency ablation (RFA). Preoperative, intraoperative, and postoperative duplex ultrasound scans were obtained using standard protocols to establish reflux and target vein diameter. Intraoperative measurements were performed from the catheter tip to the femoral vein margin. Duplex ultrasound studies were obtained between 5 and 7 days after the procedure, with 1-month follow-up. The relationship between catheter tip positioning and vein diameter with the length of the proximal patent GSV segment after ablation and the incidence of proximal thrombus extension were analyzed. RFA was performed in 73 patients. Intraoperatively, the mean catheter tip positioning distance was 2.75 cm (range, 2.4-3.0 cm) from the saphenofemoral junction (SFJ), with 93% of the catheters placed within 2.6 to 2.9 cm of the femoral vein. The GSV mean diameter at the SFJ was 0.90 cm (range, 0.37-1.88 cm). After RFA, all GSVs were occluded, with a mean residual patent proximal GSV length of 1.17 cm (range, 0.3-10 cm). Two patients demonstrated thrombus extension from the SFJ into the femoral vein for a 2.7% incidence of endovenous heat-induced thrombosis. In patients undergoing RFA for saphenous reflux, neither catheter tip positioning nor vein diameter correlates with the length of the proximal patent segment of GSV after ablation. In addition, catheter positioning does not decrease the incidence of proximal thrombus extension into the femoral vein.

Endoscopic Vein Harvesting for Coronary Bypass Grafting: A Blessing or a Trojan Horse?

Conventional open harvest of the great saphenous vein (GSV) during CABG results in approximately 7% donor-site complications. Using endoscopic vein harvesting (EVH) the full GSV length can be harvested through a 3 cm incision. This nonsystematic review discusses several key issues concerning EVH, based on an extensive Pubmed search. Found studies show that EVH results in reduced number of wound complications, less postoperative pain, earlier postoperative mobilisation, reduced length of hospital stay, and is more cost-effective. Initial studies did not find significant differences in graft histology, patency, or clinical outcome. However, in 2009 convincing evidence of inferior histological graft properties became available. Furthermore, an observational study showed that EVH resulted in significantly more graft stenosis, was associated with higher mortality, more myocard infarction, and more reinterventions. Most recent publications could not confirm these findings, however larger randomised controlled trials focusing on graft quality are being awaited.

Factors Influencing the Effectiveness of Endovenous Laser Ablation (EVLA) in the Treatment of Great Saphenous Vein Reflux

Endovenous laser ablation (EVLA) is an alternative to surgery for treating sapheno-femoral and great saphenous vein (GSV) reflux. This study assesses factors that might influence its effectiveness. Prospective, observational study. EVLA was used to treat the great saphenous vein in 644 limbs as part of the management of varicose veins. Body mass index (BMI), maximum GSV diameter, length of vein treated, total laser energy (TLE) and energy density (ED: Joules/cm) delivered were recorded prospectively. Data from limbs with ultrasound confirmed GSV occlusion at 3-months were compared with those where the GSV was partially occluded or patent. Complications were recorded prospectively. GSV occlusion was achieved in 599/644 (93%) limbs (group A). In 45 limbs (group B) the vein was partially occluded (n=19) or patent (n=26). Neither BMI [group A: 25.2 (23.0-28.5); group B: 25.1 (24.3-26.2)], nor GSV diameter [A: 7.2mm (5.6-9.2); B: 6.9 mm (5.5-7.7)] influenced success. TLE and ED were greater p<0.01) in group A (median [inter-quartile range]: 1877J (997-2350), 48 (37-59)J/cm) compared to group B (1191J (1032-1406), 37 (30-46)J/cm). Although TLE reflects the greater length of GSV ablated in Group A (33 cm v 29 cm, p=0.06) this does not influence ED. GSV occlusion always occurred when ED>/=60 J/cm with no increase in complications. ED (J/cm) of laser delivery is the main determinant of successful GSV ablation following EVLA.

Endovenous Laser Ablation of the Great Saphenous Vein with a 980-nm Diode Laser in Continuous Mode: Early Treatment Failures and Successful Repeat Treatments

To investigate the efficacy of lower-energy endovenous laser treatment for great saphenous vein (GSV) incompetence and treatment parameters associated with early treatment failure. Sixty consecutive endovenous laser treatments (32 left, 28 right; 57 initial treatments, three repeat treatments) in 48 patients (13 men, 35 women; mean age, 55.2 +/- 12.9 years), with bilateral treatments in nine patients, were studied. Preprocedural clinical signs, etiology, anatomy, and physiologic classifications demonstrated class 2 limbs in 11.7% of cases, class 3 limbs in 25.0%, class 4 limbs in 48.3%, and class 5 limbs in 15.0%. All initial and repeat treatments were performed with lower-energy with use of a 980-nm diode endovenous laser at 11 W in continuous mode. Patients wore class II compression stockings for 2 weeks and were followed up at 1, 3, and 6 months with clinical and duplex ultrasound examinations. Treatment failures were diagnosed at 3 months on the basis of GSV patency or lack of clinical improvement. Diameter and length of GSV treated, treatment energy parameters, and clinical outcomes were prospectively measured and compared between successful and failed treatments. The initial treatment success rate was 94.7% (54 of 57). The mean maximum diameter of successfully treated GSVs was 1.12 +/- 0.52 cm, and the mean maximum diameter of GSVs in which treatment failure occurred was 2.05 +/- 0.23 cm (P = .008). Mean total energy applied for successful treatments was 1,131.3 +/- 248.1 J, and mean total energy applied for failed treatments was 1,439.6 +/- 425.0 J (P = 0.053). Mean unit energy applied for successful treatments was 32.7 +/- 7.5 J/cm, and that for failed treatments was 32.8 +/- 4.9 J/cm (P = .986). All patients in whom treatment failed were successfully treated again with a mean total energy of 1,393.0 +/- 81.0 J and a mean unit energy of 29.4 +/- 4.9 J/cm. There were no significant differences in mean total energy or unit energy applied among successful, failed, and repeat treatments (P > .05). Mean follow-up duration was 6.8 months. Endovenous laser treatment with lower energy appears to be safe and effective. Larger GSV diameter is associated with early treatment failures.

Lower Energy Endovenous Laser Ablation of the Great Saphenous Vein with 980 nm Diode Laser in Continuous Mode

To assess clinical outcomes, complication rates, and unit energy applied using 980 nm diode endovenous laser treatment at 11 watts for symptomatic great saphenous vein (GSV) incompetence and reflux disease. Thirty-four consecutive ablation therapies with a 980 nm diode endovenous laser at 11 watts were studied. The diagnosis of GSV incompetence with reflux was made by clinical evaluation and duplex Doppler examinations. The treated GSVs had a mean diameter of 1.19 cm (range 0.5-2.2 cm). The patients were followed with clinical evaluation and color flow duplex studies up to 18.5 months (mean 12.19 months +/- 4.18). Using 980 nm diode endovenous laser ablation in continuous mode, 100% technical success was noted. The mean length of GSVs treated was 33.82 cm (range 15-45 cm). The mean energy applied during the treatment was 1,155.81 joules (J) +/- 239.50 (range 545.40-1620 J) for a mean treatment duration of 90.77 sec +/- 21.77. The average laser fiber withdrawal speed was 0.35 cm/sec +/- 0.054. The mean energy applied per length of GSV was 35.16 J/cm +/- 8.43. Energy fluence, calculated separately for each patient, averaged 9.82 J/cm(2) +/- 4.97. At up to 18.5 months follow-up (mean 12.19 months), 0% recanalization was noted; 92% clinical improvement was achieved. There was no major complication. Minor complications included 1 patient with hematoma at the percutaneous venotomy site, 1 patient with thrombophlebitis on superficial tributary varices of the treated GSV, 24% ecchymoses, and 32% self-limiting hypersensitivity/tenderness/"pulling" sensation along the treatment area. One patient developed temporary paresthesia. Four endovenous laser ablation treatments (12%) were followed by adjunctive sclerotherapies for improved cosmetic results. Endovenous laser ablation treatment of GSV using a 980 nm diode laser at 11 watts in continuous mode appears safe and effective. Mean energy applied per treated GSV length of 35.16 J/cm or mean laser fluence of 9.82 J/cm(2) appears adequate, resulting in 0% recanalization and low minor complication rates.

Can the Main Trunk of Greater Saphenous Vein be Spared in Patients with Varicose Veins?

Greater saphenous vein (GSV) is the first-choice venous conduit used for bypass grafting. However, GSV is more often varicosed than any other vein. The purpose of this study was to identify how often the main trunk of GSV could be spared during varicose vein oper ations. Two hundred fifty limbs from 187 consecutive patients with GSV reflux on contin uous-wave Doppler were subsequently examined with color flow duplex imaging. The main trunk of GSV was divided into saphenofemoral junction (SFJ), thigh, knee, and below-the-knee (BK) segments. Reflux and varicosities at all levels were noted. Limbs with previous venous surgery involving GSV were excluded from the study. Reflux throughout the length of GSV was the most common pattern (n=122, 49%). The prevalence of reflux at the SFJ was 78% (n=196); thigh segment, 84% (n=210); knee, 92% (n=229); and BK segment, 74% (n=186). Of the segments with reflux, vari cosities were found in 71% at the thigh, 77% at the knee, and 28% (P&lt;0.0001) at the BK segment. Despite the presence of reflux, the entire length of GSV was free of varicosities in 46 (18%) limbs. Because the main trunk of GSV most often lies deeper than its tribu- taries, in 79 (32%) limbs it was not possible to clinically detect the presence of GSV vari cosities. Those varicosities that were clinically evident most often involved the tributaries of GSV (n=232, 93%) that pierce the superficial fascia and come closer to the skin. One hundred thirty-two incompetent perforating veins were found in 71 limbs, of which 27 were connected with the thigh segment, 5 with the knee segment, and the remaining 100 with the tributaries of the BK segment. No perforating vein was found to be connected with the BK GSV. The main GSV trunk at the BK level frequently had reflux, but it was rarely varicosed. Because this segment of GSV is not connected to perforating veins, and owing to its intimate anatomic relationship with the saphenous nerve, it may be spared if not varicosed. In about a fifth of the occasions, the entire length of GSV was free of vari cosities, and at least in high-risk patients for arterial disease this vein need not be excised.

3.13 Characterization of cellular density and determination of neointimal extracellular matrix constituents in human lower extremity vein graft stenoses

To determine predictors of recanalization in patients treated with endovenous cyanoacrylate.Follow-up by serial clinical and duplex examinations was performed at 1 week, 1 month, 6 months, 12 months, and 24 months of 108 legs in 55 patients (21 men, median age 65 y) with primary varicose veins treated with endovenous cyanoacrylate. Cox regression analysis was used to examine venous characteristics before the procedure: diameter of great saphenous vein (GSV), treatment length of GSV, presence of incompetent perforators, clinical severity of varicose vein, and experience of operator as predictors of recanalization. With the patient in supine position, GSV diameter was measured at 3 levels (proximal thigh 1 cm from saphenofemoral junction, midthigh, and distal thigh above knee).Of 108 legs, 2 had minimal extension of thrombus to deep vein, and 4 had superficial thrombophlebitis. Kaplan-Meier analysis showed GSV closure rates were 97.2%, 92.3%, 89.2%, and 75.7% at 1 week, 1 month, 6 months, and 12 months after the procedure. With a median follow-up period of 5 months (range, 0–18 months), 4 legs had clinical recurrence. Mean GSV diameter ≥ 6.6 mm was the only significant predictor for recanalization (hazard ratio 12.1; 95% CI, 1.6–92.7; P = .016).The use of endovenous cyanoacrylate to treat varicose veins caused by incompetent GSV was safe. GSVs < 6.6 mm in diameter had a closure rate of 90.0% at 12 months. Despite 97.2% closure rates at 1 week, recanalization was observed in GSVs with larger diameter.