Saphenofemoral Junction Incompetence Research Articles

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

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

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.

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.

Comparative study between Cyanoacrylate Embolization and Radiofrequency Ablation in varicose veins with Incompetent Sapheno-femoral junction

Comparative study between Cyanoacrylate Embolization and Radiofrequency Ablation in varicose veins with Incompetent Sapheno-femoral junction

A Non-Randomised Prospective Study Comparing the Efficacy of Endovenous Laser Therapy and Trendelenburg?s Procedure for Sapheno-Femoral Junction Incompetence

A Non-Randomised Prospective Study Comparing the Efficacy of Endovenous Laser Therapy and Trendelenburg?s Procedure for Sapheno-Femoral Junction Incompetence

Fate of minor lower limb varicosities after Endovenous Thermal Ablation in patients with lower limb Varicose veins with incompetent Sapheno-femoral Junction

Objectives This was an open-label randomized comparative two arms study to assess the efficacy and clinical outcome of endovenous thermal ablation on reticular veins and telangiectasias in patients with lower limbs varicose veins with incompetent Sapheno-femoral Junction. Patients and methods A total of 40 patients [15 (37.5%) males and 25 (62.5%) females] with reflux of the long saphenous vein were subjected to radiofrequency ablation (RFA). 20 patients had RFA alone while the other 20 patients underwent RFA and injection sclerotherapy. Then patients were followed up on 1 week after the procedure, 3 months, 6 months, and 1 year by duplex and clinically using venous clinical severity score. Results There were 37.5% males and 62.5% females. There was a statistically significant difference in both groups regarding patients’ symptoms (pain, heaviness, and swelling) before and after serial times of follow-up, which was assessed by the VCSS, denoting marked improvement of patients’ symptoms. Also, there was a statistically significant difference (P&lt;0.001) concerning duplex results regards the reflux before and following RFA. Reticular veins follow-up, we found that in group A they were present among 35% of patients on 1-week follow-up. This increased to reach 70% after 1 year of follow-up, however, in group B they were absent among all patients on 1 week follow-up. They were present among 15% of patients after 1 year of follow-up. Conclusion RFA with concomitant sclerotherapy for the associated minor veins have proved to be safe, cost-effective and more patient satisfaction than RFA without concomitant sclerotherapy.

Randomized Controlled Trial of Great Saphenous Vein Endovenous Laser Ablation by 1940-nm Radial Fiber Using High and Low Energy in Symptomatic Patients with Varicose Veins and Saphenofemoral Junction Incompetence

Randomized Controlled Trial of Great Saphenous Vein Endovenous Laser Ablation by 1940-nm Radial Fiber Using High and Low Energy in Symptomatic Patients with Varicose Veins and Saphenofemoral Junction Incompetence

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.

Great saphenous vein aneurysm mimicking inguinal hernia: a case report

BackgroundDiagnosis of venous aneurysm may be difficult and can be misjudged as mass-like lesions, including hernias. Here we present the case of a patient with a great saphenous vein aneurysm misdiagnosed and operated as an inguinal hernia.Case presentationA 39-year-old Middle Eastern/Persian male presented with left inguinal bulging 15 years ago, which was misdiagnosed and operated on with a diagnosis of inguinal hernia. He was referred to our clinic, in which color Doppler sonography revealed left-sided saphenofemoral junction incompetence with severe flow reversal during the Valsalva maneuver, in favor of a great saphenous vein aneurysm. Ligation of left saphenofemoral junction and stripping of saphenous vein, and stab avulsion phlebotomy of left lower extremity varicose veins, were done. He was discharged the next day after the operation with an uneventful postoperative course or complication on follow-up.ConclusionVenous aneurysms can be misdiagnosed as other, more common, mass-like lesions, such as inguinal hernias. Therefore, our report emphasizes the consideration of thorough assessment and utilization of color duplex sonography to prevent further misdiagnosis and unnecessary intervention and operations.

Postoperative Outcomes of Microphlebectomy and Trendelenburg Operation with Stripping for Saphenofemoral Junction Incompetence

Postoperative Outcomes of Microphlebectomy and Trendelenburg Operation with Stripping for Saphenofemoral Junction Incompetence

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.

A Study of Demographic Factors and Clinical Profile of Varicose Veins in Adults

BACKGROUND&#x0D; Varicose veins in lower limbs cause a lot of morbidity in humans and a significant financial burden on the health care system. Varicose veins do not threaten life and are seldom disabling. A high prevalence of varicose veins has been documented in India. Hence, we decided to conduct a study on the demographic factors and clinical profile of varicose veins in adults.&#x0D; METHODS&#x0D; It is an observational study. 200 patients aged&gt;12 years with varicose veins of the lower limbs were studied. Statistical Analysis was performed with help of Epi Info (TM) 7.2.2.2.&#x0D; RESULTS&#x0D; 200 patients were studied, of whom 87.5 % were aged ≥ 35 Years; 74.5 % were males, 25.5 % were females; 70.0 % had normal BMI, 75.9 % were from the urban area, 11.5 % had a family history of varicose veins, 10.5 % had addictions, 57.0 % had a duration of standing &gt;5 hours. 62.0 % were examined at OPD, 82.5 % were unilateral and 17.5 % bilateral. The heights of the patients were significantly higher than the normal height of average Indians. The most common symptoms were varicosities and pain present in 80.85 % and 71.49 % of cases respectively. Out of 235 lower limbs, 48.93 % had the involvement of only GSV, 18.72 % only SSV, 32.35 % both; incompetent saphenofemoral junction was present in 67.24 % clinically and 74.89 % radiologically; 150 mid-thigh, 62 above-knee, 55 below-knee, 106 calf, 72 ankle perforators were incompetent clinically; 165 mid-thigh, 80 above-knee, 65 below-knee, 118 calf, 95 ankle perforators were incompetent radiologically; 65 (27.66 %) belonged to C2 class, 60 (25.53 %) to C4 class and 60 (25.53 %) to C6 class.&#x0D; CONCLUSIONS&#x0D; Age &gt; 35 years, male gender, tall height, and prolonged standing are associated with increased risk of varicose veins whereas obesity, family history and addictions do not have any association. Varicose veins are more commonly unilateral with the involvement of a great saphenous vein. Colour Doppler is better at detecting incompetent perforators compared to clinical assessment.

Correlation of Clinical Class with Duplex Ultrasound Findings in Lower Limb Chronic Venous Disease

BackgroundThis study investigated the distribution of valve incompetence in patients with chronic venous disease (CVD) and its correlation with the clinical category of the clinical, etiological, anatomical, and pathophysiological (CEAP) classification.MethodsIn total, 1,386 limbs with clinically suspected CVD were categorized according to the CEAP classification and consecutively underwent duplex ultrasonography between April 2017 and December 2020.ResultsThere were 362 limbs in male patients and 1,024 limbs in female patients. The limbs were classified as C0s–C1 (608 limbs, 43.8%), C2 (727 limbs, 52.5%), or C3–C6 (51 limbs, 3.7%). The prevalence of saphenous vein incompetence in CEAP C0s–C1 limbs was 43.6%. The saphenofemoral junction (SFJ) was competent in 37% of CEAP C2–C6 limbs. The CEAP C3–C6 category was not correlated with reflux patterns of the saphenous vein system (Cramer’s V=0.07), incompetent SFJ (Cramer’s V=0.07), deep vein reflux (Cramer’s V=0.03), or the distribution of incompetent segments in the great saphenous vein (GSV) (Cramer’s V=0.11).ConclusionDuplex ultrasonography is necessary to formulate a proper treatment plan for limbs categorized as CEAP C0s–C1. The SFJ was competent in more than one-third of CEAP C2–C6 limbs with GSV reflux; as such, flush ligation of the GSV may be unnecessary in these patients. The CEAP C3–C6 category showed no correlations with reflux patterns of the saphenous vein system, SFJ reflux, deep vein reflux, or the distribution of incompetent segments in the GSV.

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.

Frequency of Sapheno-Femoral Junction and Sapheno-Popliteal Junction Incompetence on Duplex Ultrasonography in Patients with Varicose Veins

Objective: To determine frequency of sapheno-femoral junction (SFJ) and sapheno-popliteal junction (SPJ) incompetence on duplex ultrasonography in patients with varicose veins.Study Design: Cross-sectional study.Place and Duration of Study: Shaikh Khalifa Bin Zayed Al-Nahyan/Combined Military Hospital, Rawalakot, Azad Jammu &amp; Kashmir, from Aug 2019 to Feb 2020.Methodology: A total of 70 patients were selected using non-probability, consecutive sampling. After ethical approval, informed consent and relevant history taking, duplex ultrasonography (DUS) was done in standing and supine positions in patients with varicose veins, fulfilling inclusion and exclusion criteria. Presence or absence of SFJ and SPJ incompetence was assessed.Results: Mean age was 41.99 ± 11.08 years with 36 (51.43%) patients between 36-50 years. Mean duration of disease was 6.33 ± 2.29 months while 47 (67.14%) patients had symptoms for more than 6 months at the time of presentation. Occupation wise, 40 (57.14%) patients were field workers while 30 (42.86%) were office and domestic workers. Isolated SFJ, SPJ and combined junction incompetence were found in 27 (38.57%), 20 (28.57%) and 23 (32.86%) patients respectively. Both SFJ and SPJ incompetence were more in obese patients (78.6% and 71.4% respectively) as compared to non-obese patients.&#x0D; Conclusion: Frequency of SFJ incompetence was more than SPJ incompetence on DUS. Obesity, male gender and prolonged motionless standing predispose to the development of varicose veins. Preventive measures and early diagnosis can decrease disease burden.

AN ALTERNATE MODALITY OF STRIPPING OF VARICOSE VEINS

Varicose veins are very common clinical condition characterised by permanently dilated torturous elongated veins in the leg which is due to incompetence of valves. Risk factors being heredity, occupations of prolong standing, immobility, raised intra abdominal pressure, raised progesterone level, altered oestrogen-progesterone ratio etc. A 27 years old patient with no h/o any systemic disease or co morbidities came with complaints of dilated, tortuous veins in the left lower limb extending from mid-thigh to ankle region since 2 months. Since 1 month the patient was having dull aching pain over the left lower limb on walking and prolonged standing. A thorough clinical examination was done with findings of incompetent Sapheno-femoral junction(SFJ) and perforator incompetence of the left lower limb. A venous Doppler of the left lower limb revealed SFJ dilated and incompetent and Incompetent perforators along the GSV 5 cm below the knee. Following all routine preoperative work-ups, patient was posted for surgery. After ligating all the tributarirs of GSV, while checking the metallic stripper, it snapped in between and was not in a useable condition and there was no other metallic stripper in the OT. Decision had to be taken for an alternative the GSV was sucessfully stripped using a 14F Neltons catheter. Thus as an alternative to metallic stripper, a Neltons catheter can also be used for stripping varicose veins.

Postoperative outcomes of microphlebectomy and Trendelenburg operation with stripping for saphenofemoral junction incompetence

Background: With more than 10 million cases occurring annually in India, varicose veins can sometimes result in severe discomfort and pain besides disfiguration of skin. The objective of the study was to assess the most viable treatment options for varicose veins between the traditional Trendelenburg procedure and microphlebectomy.Methods: This was an interventional study conducted at a tertiary center in South India. Patients above 18 years of age, presenting with varicose veins due to saphenofemoral junction (SFJ) incompetence and scheduled for surgical management, were included in a sample size of 46. Subjects were randomized into two groups – Group 1 underwent micro phlebectomy and Group 2 underwent Trendelenburg operation with stripping of great saphenous vein (GSV). Postoperative pain was assessed on day of surgery, day after, and postoperative day 7. A venous Doppler ultrasound was conducted 6 weeks after the surgical procedure, to look for reflux at SFJ.Results: Group 1 subjects reported lesser immediate postoperative pain and incurred significantly less cost as determined by an independent sample t-test. Chi-square test found no significant difference in the rate of occurrence of local complications (P > 0.05), and no recurrence was noted among both groups.Conclusion: Microphlebectomy is a more feasible treatment option than Trendelenburg operation with GSV stripping on account of lower costs. It is also a patient friendly alternative due to immediate reduction in pain.

Ultrasound color duplex parameters of patients presenting with lower limb varicose veins at outpatient department of university hospital of Nepal

Background: Varicose vein is prominent dilated veins of lower limbs. Incomplete treatment and local recurrence are still the clinical challenge among the vascular surgeons. We aim to evaluate the range of imaging on color duplex describing the anatomy of veins, their variants, valve competencies, territories of defective venous system, demographic data, and the factors contributing among the patients referred to Vascular Outpatient Department of Kathmandu University Hospital. Objective: The aim was to know the ultrasound (US) color duplex parameters of superficial venous system in varicose vein. Materials and Methods: We included 299 patients during the study of 6 months with varicose veins for detailed US Doppler analysis. Gray-scale US was done to study the anatomy of veins followed by color duplex and color duplex spectrometry to determine the reflux of the superficial venous system. Quantification of reflux was determined by the use of Valsalva maneuver. Association of great saphenous vein (GSV) cross-sectional diameter and saphenofemoral junction incompetence was also studied. Results: Of 299 varicose vein cases, 52.50% were female. Among involved cases, the mean of GSV diameter was 5.43 mm in the right and 5.68 mm in the left. Saphenofemoral junction diameter was 7.89 mm in the right and 8.17 mm in the left. Receiver operative characteristics curve showed GSV diameter at femoral condyl of 4.5 mm as best cutoff value for the diagnosis saphenofemoral junction reflux. Conclusions: US color duplex is investigation of choice for varicose vein as a preoperative analysis tool, quantifying the superficial valve incompetency, studying and mapping the venous anatomy, and planning the surgery.

Epidemiological Study of Ulcers of the Lower Limb in a Tertiary Care Teaching Institute

Lower limb ulcers are common in old age group there are several causes which includes venous valve insufficiency, diabetes mellitus, skin malignancies. We in the present study tried to evaluate the epidemiology of population affected with lower limb ulcers and treatment and outcome of such conditions. Methods: This cross-sectional study was conducted in the Department of General Surgery, Prathima Institute of Medical Sciences, Nagnur, Karimnagar. All cases of leg ulcers reporting to this institute except those which occur due to trauma and in children &lt; 12 years of age were included in the study. Result: In the study n=50 cases of both sexes with leg ulcers were included. The most commonly involved age group was &gt; 70 years. Diabetic ulcers were detected in 44% of cases in males and 18% of cases in females. In the cases right limb was involved in n=24(48%) cases and left limb was involved in n=23(46%) of cases and bilateral involvement was found in n=3(6%) of cases. The predominating organism found was Staphylococcus aureusfollowed by Klebsiellaand streptococcus. Conclusion: The study found that found to be ulcer of the leg associated with diabetes mellitus, ulcer due to venous valve incompetence. The diabetic ulcer was more common in males, more prevalent in patients above the age of 51 years. Venous ulcers are commonly seen are saphenofemoral junction incompetence and perforator incompetence. As far as the treatment of these cases is concerned the use of antibiotics and dressings helps to a great deal in management. Skin grafting may be considered with wide defects where healing is difficult without grafts.