Incompetent Perforating Veins Research Articles

The effectiveness of minimally invasive surgical techniques for treating patients with chronic venous insufficiency in the stage of trophic disorders: comparative study

Introduction. Despite the active introduction of minimally invasive techniques into modern phlebology, the problem of surgical treatment of chronic venous insufficiency (CVI) in the stage of trophic disorders is still far from being finally resolved, especially problems of horizontal reflux.Aim. Тo comparatively evaluate the results of using various tactics of minimally invasive surgical treatment in patients with lower extremitiesʹs CVI in the stage of trophic disorders.Materials and methods. A study at 139 patients with CVI at the stage of trophic disorders was carried out. Group 1 (n = 79) included patients who underwent endovasal laser coagulation of the trunks of the great and small saphenous veins (GSV and SSV) with microfoam sclerotherapy of varicose perforating veins. In group 2 (n = 60) – method of intervention was determined by the diameter of Cockettʹs perforants.Results. Indicators of the early postoperative period in the study groups were comparable. After 2 months, no cases of relapse in the GSV and SSV were registered. Recurrence of horizontal reflux was observed only in 6 (7.6%) people in group 1. In long-term postoperative follow-up, decrease in the severity of the disease according to the VCSS scale was found in both groups (p < 0.001). The persistence of pathological reflux along was observed in 16 (22.5%) patients of group 1. Moreover, in 62.5% and 68.75% cases of relapses, the perforants had, respectively, a large diameter and high blood flowʹs speed.Discussion. In general, minimally invasive techniques used demonstrated comparable clinical results and high efficiency. At the same time, the importance of preoperative assessment and taking into account the properties of perforants has been proven.Conclusion. The claimed method should be considered as an effective and safety method of obliteration of incompetent perforating veins at severe forms of CVI.

Application of the ankle pump method in a sitting position to evaluate calf perforating veins by color Doppler ultrasound

ObjectiveWe investigated the feasibility and efficacy of assessing calf perforating veins (PVs) using the ankle pump in a sitting position (AP-sit) method by color Doppler ultrasound. MethodsWe performed a multicenter prospective clinical trial between November 2022 and October 2023. Eligible patients with chronic venous disease and healthy controls were enrolled. The calf PVs were assessed using three different methods: manual compression in a standing position, manual compression in a sitting position, and AP-sit method. The reflux durations and detection rate of incompetent PVs (IPVs) were compared among the three methods. The number and diameter of calf PVs and distribution of IPVs were analyzed. ResultsA total of 50 patients with chronic venous disease and 50 healthy controls were included. There were 173 calves analyzed, including 97 healthy calves and 76 calves with chronic venous disease. The number of PVs per calf was higher in the diseased calves (median, 7.0; interquartile range [IQR], 6.0-8.0) than in the healthy calves (median, 5.0; IQR, 3.0-6.0; P < .001). The diameter of IPVs (median, 2.3 mm; IQR, 2.0-3.1 mm) was larger than that of competent PVs (median, 1.4 mm; IQR, 1.2-1.7 mm). Most of the IPVs (78.8%) were located in the medial and posterior middle of the calf. The reflux duration induced by the AP-sit method was greater than that induced by the manual compression methods (P < .001). Although the AP-sit method had a higher detection rate (92.0%) of IPVs than the manual compression methods (71.7% and 74.3% for standing and sitting, respectively; P < .001), especially in the distal lower leg, the manual compression methods found IPVs not found using the AP-sit method. ConclusionsDiseased calves with chronic venous disease have more PVs than do healthy calves. IPVs are commonly larger than competent PVs, with most IPVs located in the medial and posterior middle of the calf. Most importantly, the AP-sit method provides a convenient and effective approach for assessing the calf PVs, especially those located in the distal calf, as an alternative or complementary method to traditional manual compression, which is valuable in the daily practice of sonographers.

Pretibial Varicose Vein from Intraosseous Perforating Vein Incompetence

Pretibial Varicose Vein from Intraosseous Perforating Vein Incompetence

Atypical Forms of Lower Limb Varicose Vein Disease: Features of Diagnosis and Surgical Treatment

INTRODUCTION: Lower limb varicose vein disease (LLVVD) is the most common vascular disease with a predominant lesion of the main trunks of saphenous veins. At the same time, there exist atypical variants of lesion of the venous system in LLVVD, which cause difficulties in diagnosis and treatment.&#x0D; AIM: To study the incidence rate, anatomical bases of the varicose transformation, the features of reflux formation and the results of surgical treatment in atypical forms of LLVVD.&#x0D; MATERIALS AND METHODS: The study involved 600 patients with LLVVD, C2-C3 class of clinical manifestations in CEAP classification; 82 of them had atypical forms. The mean age of patients was 40.2 ± 9.2 years, duration of disease 15.0 ± 5.6 years. Duplex scanning of the lower limb venous system was conducted according to Russian recommendations for the diagnosis and treatment of chronic venous disorders of lower limbs of 2018. Patients with atypical forms of LLVVD additionally underwent computed tomography of the venous system with contrast. Surgical treatment of 50 patients with atypical forms of LLVVD included separation of the site of opening of a tributary in the area of saphenofemoral junction after preliminary marking and isolated elimination of varicose tributaries using Muller hooks; incompetent perforating veins were ligated at the epi- or subfascial levels depending on the location. The results were considered in the periods for up to two years.&#x0D; RESULTS: According to our data, the incidence of atypical forms of LLVVD was 13.7%. Lesion of the large tributaries of the main saphenous veins accounted for the highest proportion of atypical forms of LLVVD — 68.3%. Of these, varicose transformation of the anterolateral tributary made 98.2%, and of the superficial iliac circumflex vein — 1.8%. Isolated varicose transformation of perforating veins occurred in 31.7% of cases, where transformation of perforating veins of the gluteal area made 7.7%, of perforating veins of the posterolateral surface of the thigh — 46.2%, and of perforating veins of the patella region — 46.2%. The technical success in the postoperative period in the form of elimination of varicose saphenous veins and of the source of their incompetence was achieved in 100% of cases.&#x0D; CONCLUSIONS: The incidence of atypical forms of LLVVD is 13.7%, with the main trunks of saphenous veins remaining competent. The anatomical and hemodynamic basis for such forms of LLVVD is incompetence of the deep vein valves, from where the reflux is transmitted to tributaries of the saphenofemoral junction and/or perforating veins of the gluteal region, femoral region or popliteal fossa. Precise separation of varicose tributaries and perforating veins with preservation of the main trunks of subcutaneous veins is an organ-saving method of LLVVD treatment with a good effect in the follow-up period of up to two years.

Редкий вариант варикозной трансформации подкожных вен в подколенной области за счёт несостоятельной перфорантной вены

INTRODUCTION: Localization of varicose-transformed subcutaneous veins in the popliteal space immediately aims both ultrasound diagnostics doctors and surgeons for the pathology of the short saphenous vein. However, this does not always correspond to reality. A rather rare cause of transformation of subcutaneous veins may be an incompetent perforator vein. The article presents a clinical case of varicose transformation of subcutaneous veins of the popliteal region through an incompetent perforator vein. Initially, the patient was diagnosed with the bulge of the subcutaneous veins within the short saphenous vein. Subsequently, during a duplex scan in a specialized department, an incompetent perforator vein of the popliteal region was revealed, which was confirmed intraoperatively. The article also describes the structural features of the perforator vein of this localization. CONCLUSION: An incompetent perforator vein of the popliteal region may be the cause of a false positive diagnosis of varicose transformation in the system of the short saphenous vein. A large arterial branch from the popliteal artery is located next to the perforator vein of the popliteal region at the subaponeurotic level, which requires their separation before resection of the vein.

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.

Does Concomitant Truncal and Perforator Surgery Improve Outcomes For Patients With Chronic Venous Disease? Systematic Review and Meta-Analysis

Objective: Incompetent perforator veins (IPVs) are encountered frequently during ultrasound assessment of the venous system in chronic venous disease (CVD). The total number of IPVs increases substantially with the severity.1,2 Some studies have shown that concomitant treatment of truncal and perforator incompetence improves ulcer healing,3,4 yet a Cochrane review was unable to determine the potential benefits of perforator surgery in venous ulcer management due to poor quality evidence.5 This study aims to establish the exact role of concomitant IPV and truncal reflux treatment in patients with CVD.

Long-term results of minimally invasive deep reflux correction in patients with post-thrombotic disease

The OBJECTIVE was to trace the long-term results of the operation of a dosed narrowing of the femoral vein in the lower third of the thigh proposed by Professor P. G. Shvalb.METHODS AND MATERIALS. The study included 30 patients (20 men and 10 women) with post-thrombotic disease of the veins of the lower extremities of the recanalized form, C4–C6, who underwent surgical correction of deep reflux in the period from 2012 to 2013. In 23 patients, additional phlebectomy of superficial and perforating veins was performed. The research method was duplex scanning (DS). The ratio of antegrade and retrograde blood velocities was used to quantitatively characterize deep reflux. Additionally, the state of the popliteal-tibial segment of the deep veins was determined using the Psatakis reflux index.RESULTS. The positive effect of the operation was noted in 96.7 % of patients at a follow-up period of 4 years. During follow-up periods of up to 8 years, the numbers decreased to 60.7 %. Relapse of trophic ulcers occurred in 39.3 % of patients. However, all patients noted that ulcers were much smaller in size than before surgery. According to DS data, incompetent perforator veins were detected in 16 patients: in all nine patients with recurrent ulcers and in seven patients without worsening. Vein diameter, maximum and average velocities of retrograde blood flow were greater in patients with worsening: diameter – 4.2±0.5 mm, υ (m) 91.2±19.8 cm/s, υ (average) 90.5±18.5 cm/s versus a diameter of 2.9±0.5 mm, υ (m) 39±15.6 cm/s, υ (average) 35±9 cm/s (p&lt;0.05).CONCLUSIONS. Operation of dosed narrowing of the femoral vein had good clinical results in 96.7 % of follow-up periods up to 4 years, 60.7 % – after 8 years. Isolated correction of deep reflux with the preservation of insufficient perforator veins can lead to recurrence of trophic ulcers.

Incompetent perforators do care!

The problem with all reviewed papers is that the results are influenced by concomitant treatments and the assumption that the incompetent perforating veins were treated properly. The study of van Gent and Wittens 1 van Gent W. Wittens C. Influence of perforating vein surgery in patients with venous ulceration. Phlebology. 2015; 30: 127-132 Crossref PubMed Scopus (14) Google Scholar showed that, if you treat the incompetent perforators well, the recurrence rate of an ulcer decreases significantly. This finding shows the importance of persistent incompetent perforating veins in ulcer recurrence. Therefore, in this well-performed systematic review we miss the information; for if indeed all incompetent perforators were occluded and we can only conclude that, with the existing techniques and gathered documentation, we do not have proof that incompetent perforators need to be treated. However, the right conclusion needs to be that incompetent perforators do matter in the pathophysiology of a venous leg ulcer, but that we failed to treat them properly with existing techniques. Therefore, we need to improve existing techniques and especially we need to check after 3 months and 1 year to determine whether the treated incompetent perforators remain occluded and if so document what the outcome is. 2 Ho V.T. Adkar S.S. Harris E.J. Systematic review and meta-analysis of management of incompetent perforators in patients with chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2022; 10: 955-964 Google Scholar Systematic review and meta-analysis of management of incompetent perforators in patients with chronic venous insufficiencyJournal of Vascular Surgery: Venous and Lymphatic DisordersVol. 10Issue 4PreviewIncompetent perforator veins (IPVs) contribute to venous pathology and are surgically treated based on hemodynamic measurements, size, and the CEAP (Clinical, Etiological, Anatomical, and Pathophysiological) classification. The objective of the present study was to systematically review and synthesize the current literature regarding the surgical management of IPVs, including open ligation, subfascial endoscopic perforator surgery (SEPS), endovascular laser ablation, ultrasound-guided sclerotherapy, and radiofrequency ablation. Full-Text PDF

Diameter reflux relationship in perforating veins of patients with varicose veins and its correlation with clinical severity of disease

Treatment of chronic venous insufficiency requires understanding of the hemodynamics of perforating veins. Color Doppler analysis is the best modality to understand the hemodynamics of perforators. Perforating veins were categorized as competent or incompetent depending on the duration of reflux. Perforating veins in which duration of reflux was more than 0.5 seconds were categorized as incompetent perforating veins and perforating veins with reflux less than 0.5 seconds were categorized as competent perforating veins. The average diameter of incompetent perforators was increasing with increasing severity of disease. The number of incompetent perforator per limb also increased with worsening of disease severity and it was significantly higher in CEAP classes 4–6 compared to CEAP classes from 1 to 3 (p&lt;0.05). The average diameter of incompetent perforator in the present study was 3.8mm.

Current Best Practice in the Management of Varicose Veins.

This article outlines the current best practice in the management of varicose veins. “Varicose veins” traditionally means bulging veins, usually seen on the legs, when standing. It is now a general term used to describe these bulging veins, and also underlying incompetent veins that reflux and cause the surface varicose veins. Importantly, “varicose veins” is often used for superficial venous reflux even in the absence of visible bulging veins. These can be simply called “hidden varicose veins”. Varicose veins usually deteriorate, progressing to discomfort, swollen ankles, skin damage, leg ulcers, superficial venous thrombosis and venous bleeds. Patients with varicose veins and symptoms or signs have a significant advantage in having treatment over conservative treatment with compression stockings or venotropic drugs. Small varicose veins or telangiectasia without symptoms or signs can be treated for cosmetic reasons. However, most have underlying venous reflux from saphenous, perforator or local “feeding veins” and so investigation with venous duplex should be mandatory before treatment. Best practice for investigating leg varicose veins is venous duplex ultrasound in the erect position, performed by a specialist trained in ultrasonography optimally not the doctor who performs the treatment. Pelvic vein reflux is best investigated with transvaginal duplex ultrasound (TVS), performed using the Holdstock-Harrison protocol. In men or women unable to have TVS, venography or cross-sectional imaging is needed. Best practice for treating truncal vein incompetence is endovenous thermal ablation. Increasing evidence suggests that significant incompetent perforating veins should be found and treated by thermal ablation using the transluminal occlusion of perforator (TRLOP) approach, and that incompetent pelvic veins refluxing into symptomatic varicose veins in the genital region or leg should be treated by coil embolisation. Bulging varicosities should be treated by phlebectomy at the time of truncal vein ablation. Monitoring and reporting outcomes is essential for doctors and patients; hence, participation in a venous registry should probably be mandatory.

Feasibility of incompetent perforator vein excision using stab avulsion.

ObjectivesWhether incompetent perforator veins (IPVs) require treatment remains controversial. We retrospectively evaluated the feasibility of IPV excision performed using the stab avulsion technique without ligation and sutures in patients undergoing endovenous ablation (EA).MethodsThis was a single-center, retrospective, observational cohort study. EA was performed in 1503 consecutive patients, including 33 patients with ulcers, between December 2014 and May 2021. Varicectomy was performed using the stab avulsion technique; IPV cases were included.ResultsStab avulsion was performed at a mean number of 11.4 ± 7.8 sites. No deep vein thromboses or pulmonary emboli were noted. The incidence of nerve injury was 0.3%. All 33 (100%) patients with ulcers achieved healing by 1 year (median: 55.5 days; range: 13–365 days).ConclusionsIPV excision via stab avulsion may be a viable option for treating varicose veins and ulcers. This technique offers multiple advantages, including simplicity, safety, and reduced healthcare costs.

Four-dimensional Computed Tomography Using Antegrade Venography to Detect Incompetent Perforating Veins

Four-dimensional Computed Tomography Using Antegrade Venography to Detect Incompetent Perforating Veins

Subfascial aneurysm of the incompetent popliteal perforator vein: case series overview and novel minimally invasive approach presentation

Subfascial aneurysm of the incompetent popliteal perforator vein: case series overview and novel minimally invasive approach presentation

Relationship between incompetent perforator veins and pigmentation below the knee in patients with chronic venous disease

ObjectiveThe aim of the present study was to evaluate the correlation between incompetent perforator veins (PVs) and venous pigmentation. MethodsA total of 203 limbs of patients with chronic venous disease were studied. The limbs were classified into two groups: C2 group (varicose veins) and C4a group (skin changes with pigmentation). The PVs of the lower legs were examined using Doppler ultrasound. The diameter, reflux duration, and peak velocities were measured and analyzed. The pigmentation area in the lower leg was also studied. ResultsPigmentation in the lower legs was significantly associated with venous insufficiency of the PVs. The prevalence of PVs insufficiency was higher for the C4a patients compared with the C2 patients (96 of 164 [58.3%] vs 4 of 39 [10.3%]; P < .001). The presence of incompetent PVs was associated with an increased risk of pigmentation (OR, 8.977; 95% CI, 2.824-28.537; P < .001). The higher the patients’ pigmentation severity (higher VCSS), the greater the prevalence of perforator venous insufficiency (P < .001). The PVs in the areas of pigmentation were larger in diameter, required longer to reach peak velocity, and had higher peak velocities than the PVs in nonpigmented limbs (P < .01 for all). We found a linear relationship between the pigmentation area and the diameter of the PV, reflux time, and peak velocity (r = 0.272, r = 0.172, and r = 0.664, respectively; P < .05). ConclusionsIncompetent PVs are a significant risk factor for venous pigmentation and, therefore, are potentially suitable for surgical correction.

Ayurvedic management of multiple varicose ulcers due to incompetent perforator veins in lower limb-A case report

This case report is the description of multiple varicose ulcers of a 31 years old male, working as police constable. The ulcers were painful with serous discharge. In Doppler study of venous system of lower limbs, incompetent perforators were noted and condition was diagnosed as varicose ulcers. As no relief was obtained from external application of medicines as suggested by conventional treatment, patient came to the Out Patient Department (OPD) of Regional Ayurveda Research Institute, Thiruvananthapuram, Kerala. In Ayurveda, varicose ulcers can be considered as Siragranthijanya vran. Internal medications used have raktashodhak, krimighn, soolahar, vranashodhak and vranaropan properties. Leech therapy was also done. The case is unique in the sense that ulcers were in multiple sites and healed completely after 3 weeks with cost effective and non surgical measures. The presented combination of leech therapy and Ayurvedic medications was found to be a good alternative therapy in the management of nonhealing varicose ulcers.

A Strategy to Enable Rapid Healing and Prevent Recurrence of Venous Ulcers

Venous ulcers are often intractable. The aim of this study was to retrospectively analyze the effectiveness of endovenous ablation, compression therapy, moist wound healing, and skin care in the management of venous ulcers. Twenty-eight consecutive patients (10 male, 18 female; mean age, 70.1 years) with Clinical-Etiology-Anatomy-Pathophysiology (CEAP) class C6 venous ulcer underwent endovenous ablation between December 2014 and August 2020. The main treatment strategies were radiofrequency ablation and varicectomy (including stab avulsion of incompetent perforating veins), use of compression therapy until complete healing was achieved, moist wound healing (washing the ulcer site and covering it with dressings twice daily), and skin care, taking into consideration the balance of the microbiome. Active venous leg ulcers (CEAP class C6) were diagnosed in 36 patients at the first visit. In 7 of these patients, compression therapy and use of strategies to promote moist wound healing resulted in ulcer healing by the day of the planned surgery. One patient was unable to quit smoking and, therefore, could not undergo surgery. After excluding these 8 patients, the authors analyzed the data from 28 patients who underwent endovenous ablation. The mean surgical time was 38.9 minutes, and the mean number of stab avulsion incision sites was 9.7. All ulcers healed within a median of 55.5 days (range, 13-365 days). Ulcer healing was achieved by 1 year in all 28 patients (100%). No ulceration recurred as of the final follow-up (median, 24.5 months [range, 3-66 months]). Endovenous ablation, adequate varicectomy (stab avulsion [maximum number of sites in 1 patient, 43]), compression therapy, moist wound healing, and skin care are effective in treating and preventing recurrence of venous ulcers.

Клинический случай лечения венозной трофической язвы

Introduction. Varicose veins of the lower extremities with clinical form C2 and higher (if we take into account the modern international classification) is a slowly progressive disease. It needs therapy, besause if untreated, some complications can develop, such as: trophic disorders (lipodermatosclerosis, skin hyperpigmentation, trophic ulcers), bleeding from varicose veins with minimal trauma, thrombotic complications (varicothrombophlebitis, deep vein thrombosis, pulmonary embolism). Materials and methods. This article presents a description of a clinical case of an aged patient with a trophic ulcer of the lower third of the left leg against the background of varicose veins of the lower extremities in the saphenous vein system and the presence of concomitant moderate iron deficiency anemia, ischemic heart disease and hypertension. Considering these factors, endovenous radiofrequency ablation of the great saphenous vein and micro-foam echosclerotherapy of incompetent perforating veins of the leg were performed. Results and discussion. Our clinical observation of an aged patient with moderate iron deficiency anemia, ischemic heart disease and hypertension is an example of effective treatment of trophic ulcers against the background of varicose veins of the lower extremities in the saphenous vein system. Without waiting for the complete compensation of the anemia, the patient was operated on with a minimally invasive method, which contributed to the rapid healing of the trophic ulcer. As a result, after 2 weeks, the trophic ulcer decreased by 2 times, and 1 month after surgery and a 14-day course of infusion vascular therapy, the ulcer completely healed. Conclusion. Thus, in patients with an open trophic ulcer, the elimination of reflux (vertical and / or horizontal) at the initial stage of treatment creates ideal conditions for the fastest healing of the ulcer. The combination of minimally invasive methods of treatment (radiofrequency ablation and micro-foam sclerotherapy) and vascular therapy promotes rapid healing of trophic ulcers, shortens the recovery time of the body against the background of comorbid pathology, and provides a good cosmetic effect.

Treatment of chronic venous disorder: A comprehensive review.

Chronic venous disorder (CVD) is highly prevalent vascular disorder affecting up to 45% of the general population, with clinical manifestations ranging from teleangiectasias to venous leg ulcers (VLUs). We examined the currently available data in order to provide an updated, comprehensive review on treatment options of CVD. We searched MEDLINE, Cochrane, Scopus, EMBASE, ClinicalTrials, and OpenGrey databases for relevant articles in English published until November 2020. Compression treatment is the mainstay of conservative treatment. Pharmacological treatment can provide significant symptomatic relief and hence it should be considered as part of conservative treatment. Transcutaneous Lacer treatment (TCL) is a safe and effective alternative option to sclerotherapy for treatment of C1 stage. High ligation and stripping (HL/S), ultrasound-guided foam sclerotherapy (UGFS), endovenous thermal ablation (EVTA) systems and non thermal non tumescent ablation (NTNT) systems are safe and efficacious first-line options for treatment of saphenous insufficiency. Interventional treatment of co-existing incompetent perforator veins (IPVs) is not supported by contemporary evidence. Regarding deep venous insufficiency (DVI), treatment of symptomatic femoroiliocaval occlusive venous disease refractory to conservative treatment with percutaneous transluminal venoplasty stenting has produced encouraging results.

Surgical Treatment of Incompetent Perforator Veins by Subfascial Ligation

Background: Chronic venous ulceration of the leg is a common presentation in surgical clinics. Although, the majority of ulcers can be healed by simple compression. Some chronic ulcers with venous competencies require correction surgeries. We in the current study tried to study the role of Cockett and Dodd's operation of subfascial ligation of below-knee perforator veins in the treatment of varicose veins of the lower limbs. Methods: This cross-sectional study was done in the Department of General Surgery, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. N=40cases of varicosities of the lower limbs with perforatorincompetence with or without saphenofemoral incompetence. The patients were treated with perforator ligationalone with the Cockett and Dodd method or in combination with the stripping procedure. Results: The clinical classification shows C5 healed venous ulcers and C6 active venous ulcers. 64% of cases belonged to these two categories and no case of C1 was found in our study. Perforator incompetence only was found in n=25 cases where perforator ligation alone was done given in table 4. In n=15 cases, perforator ligation and stripping with or without ligation of sphenopopliteal junction was done. The minimal mean duration of stay was 5.5 days the maximal mean duration of stay was 8.0 days. Conclusion: Open subfascial perforator ligation by Cockett and Dodd's procedure is a good procedure in the treatment of primary varicose veins with perforator incompetence. The rates of complications can be largely reduced by careful patient selection and skill full operative techniques. Follow-up of patients must be done at intervals for the development of new incompetent perforating veins and varicosities which may lead to the recurrence of ulcer formation.