Ligation Of Great Saphenous Vein Research Articles

Varicose Vein Stripping with Perforator Ligation Combined With Skin Grafting For Treatment of Venous Ulcers

Objective: To demonstrate the possibility of combining two procedures, GSV stripping with perforator ligation for varicose veins and skin grafting, to treat patients with venous ulcers related to reflux in saphenous vein. Combined procedure give early better disease free life and reduces ulcer related morbidity, socio economic burden, heath care burden. Methods: A total of 30 patients were treated during the study period of which of which 22 were male and 08 were females. Among 30 patients 26 had unilateral and 4 had bilateral ulcer. Ulcers were associated with concomitant reflux of the great saphenous vein. All 30 patients underwent GSV stripping with perforator ligation and split skin grafting in same sitting of surgery. The strategy employed began by harvesting skin from the donor area from the same limb. Great saphenous vein ligation with perforator ligation was done and skin graft placed over the varicose ulcer in the same sitting of surgery. Results: In all cases there was improvement of ulcer-related symptoms and healing of the lesion. In 28 cases we achieved full skin grafting viability. In 2 cases there was graft failure due to infection. Conclusion: This combination of procedures is a valid option, with the potential to provide quicker and less expensive treatment. Combined procedure give early better disease free life.

Efficacy of endovenous microwave ablation in treating primary varicose veins of the lower extremities

Objective: To explore the efficacy of endovenous microwave ablation in treating primary varicose veins of the lower extremities. Methods: A total of 214 patients with primary varicose veins of the lower extremities in the First Affiliated Hospital of Sun Yat-sen University from January 2017 to November 2019 were included and divided into microwave ablation group (n=128) and high ligation with microwave ablation group (n=86) according to surgical approach. Further subgroups including subgroup S (diameter<10 mm) and subgroup L (diameter≥10 mm) were established. The surgical success rate, postoperative incidence and recovery of local skin numbness and ecchymosis, and the postoperative recovery of active skin ulcer were compared between the two groups and subgroups. Results: The surgical success rate was 96% (136/141) in microwave ablation group, 100% in subgroup S (116/116), and 80% in subgroup L (20/25), respectively. In addition, the surgical success rate in high ligation with microwave ablation group, subgroup S, and subgroup L was all 100% (90/90, 73/73, and 17/17). In subgroup L of microwave ablation group, the diameter of 5 great saphenous veins in patients who failed the microwave ablation was 13.0-17.1 mm. The mean follow-up time was (24±4) months in microwave ablation group and (36±6) months in high ligation with microwave ablation group, respectively. In the microwave ablation group and high ligation with microwave ablation group, the incidence of postoperative skin numbness was 15.6% and 14.4%, respectively, and the incidence of skin ecchymosis was 5.7% and 3.3%, respectively, with no statistically significant difference between the two groups (both P>0.05). The rate of active skin ulcer in the two groups was 6.4% and 15.6%, respectively, and the difference was statistically significant (P=0.020). Local skin ecchymosis in the two groups recovered within 1 month after operation. Local skin numbness in both groups recovered within the maximum 2 years of follow-up, and active skin ulcer in both groups recovered within the maximum 1 years of follow-up. Conclusion: The endovenous microwave ablation is safe and effective, especially combining with high ligation of great saphenous vein. Good follow-up results can be achieved for great saphenous vein with diameter smaller than 10 mm. However, for those with diameter greater than 10 mm, the surgical success rate of endovenous microwave ablation decreases.

The operation of Troyanov - Trendelenburg in the modern minimally invasive approach to the treatment of varicose disease with endovenous laser photocoagulation

Despite the widespread and active introduction of new minimally invasive technologies in clinical phlebology, the Troyanov - Trendelenburg operation today is an important step in the extensive complex of various methods of surgical treatment of varicose veins of the lower extremities. This intervention can be performed under local anesthesia with minimal trauma and excellent cosmetic results. The leading position in the treatment of chronic venous diseases currently takes endovenous laser photocoagulation, the implementation of which is being offered now even to patients with complicated and advanced forms of the disease. The combination of Troyanov - Trendelenburg operation and laser thermocoagulation can significantly reduce the risk of downward recanalization of the great saphenous vein, as well as eliminate side effects and complications that occur during traction of the vein. To eliminate technical errors in the course of ligation of great saphenous vein in the area of sapheno-femoral anastomosis under local infiltration anesthesia and to simplify the detection of the target vessel, especially in obese patients with severe subcutaneous fat, we have developed a method for performing Troyanov - Trendelenburg, which decreases the time of the surgical treatment of the mouth section is up to 10-15 min; the risk of possible complications is reduced. In addition, this treatment does not increase the bed-day and recovery periods. It was concluded that the use of a laser beam at the end of the working part of the fiber, previously carried out under ultrasound control directly into the area where the great saphenous vein falls into the deep system, as a visual guide, greatly facilitates the search for the main saphenous vein, especially in obese patients. The operation of Troyanov -Trendelenburg allows you to process all branches of the Delbe beam and eliminate the continued progression of thermally induced thrombosis proximal to the anastomosis, and therefore possible pulmonary thromboembolism from the large subcutaneous vein subjected to laser coagulation.

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.

下肢静脈瘤に対する高位結紮術併用硬化療法の術式変遷と長期成績

下肢静脈瘤に対する高位結紮術併用硬化療法の術式変遷と長期成績

Ultrasound assisted great saphenous vein ligation and division: an office procedure

The aim of this proof of concept study is to describe an ultrasound (US) assisted simplified surgical procedure for pre-terminal great saphenous vein (GSV) high ligation/division avoiding groin dissection and tributary interruption, in an office setting, in association to varices phlebectomy and saphenous vein foam occlusion treatment. Inclusion criteria: primary GSV reflux due to terminal valve, vein diameter &gt;6 mm. By ultrasonography in standing position, the point GSV passing over the adductor longus muscle (about 3 cm from the junction) is identified. This E (easy) point, relatively superficial, free from tributaries and other structures, allows an easy grasping and extraction of the GSV vein through a 3 mm stab incision provided an ultrasonography assistance. The vein is divided/ligated about 2 cm distal from the ostium, the distal stump is cannulated and foam is injected on the distal segment from the E-point incision in a retrograde fashion, varices are avulsed by phlebectomy. Twenty procedures in 18 patients (venous clinical severity score: mean 3.15 - GSV diameter: mean 7.34) were performed, all the cases without inconveniences, with a duration not exceeding 10 min in addition to the phlebectomy procedure time. No complications as hemorrhage, infection, nerve lesion, lymphatic leak or thrombosis have been registered. At one month the residual saphenous stump length was in average 2.16 cm with complete closure of GSV in all. Three patients have been controlled at 6 months showing GSV complete closure. The procedure described is a simple office US assisted method for GSV ligationdivision, leaving the 2 last cm of the saphenofemoral junction. It could be associated to most of the procedures in use with limited additional time and resources required.

Outcome of Endovascular Treatment in Postthrombotic Syndrome

The postthrombotic syndrome (PTS) is a chronic complication of deep venous thrombosis (DVT) that is characterized by leg swelling and ulceration. Sixty-seven cases of PTS underwent attempted endovascular treatment with success in 63 between June 2005 and June 2012. Thirty-six cases underwent endovascular treatment only and 18 cases combined with temporary femoral arteriovenous fistula, 5 cases great saphenous vein ligation and stripping whereas 4 cases with communicating branch ligation around ulcers. Stenting was successfully performed in 63 of 67 patients. The technical success rate was 94% with no mortality. Fifty-eight cases were followed up from 1 to 84 months. Stent occlusion or restenosis occurred in 17 patients. The primary and secondary patency rates were 87.9% and 93.1%, respectively, at 12 months and 70.7% and 82.8%, respectively, at 36 months. Endovascular treatment of PTS is safe and effective. It can alleviate symptoms and prevent further deterioration of patients with PTS.

Comment to: Less invasive ultrasonography-guided high ligation of great saphenous vein in endovenous laser ablation, by Okazaki Y, Orihashi K. Ann Vasc Dis 2013;6:221-5.

Endovenous laser ablation (EVLA) has two pitfalls: endovenous heat-induced thrombosis (EHIT) and great saphenous vein (GSV) recanalization. Trying to avoid these pitfalls, the authors developed a novel method of ultrasonography-guided high ligation (UGHL) as an adjunct to EVLA. After positioning a 5-F introducer sheath over a guidewire by a venous catheter above or blow the knee, the GSV at 2 cm distal to the SFJ was located by US, and 2 small 2&ndash;3-mm skin incisions were made next to the GSV under local anesthesia. The bilateral aspects of the GSV were dissected using mosquito forceps under duplex scanning guidance. The dorsal aspect of the GSV was then dissected using a Deschamps aneurysm needle, appearing as a strong echo behind the GSV. The needle, advanced to the other incision hooked a 2-0 silk thread which was pulled through to the first incision, encircling the dorsal aspect of GSV. The Deschamps needle was then advanced on the anterior aspectof the GSV for dissection, and led to the other incision carrying the thread, encircling the GSV. After EVLA of the GSV was completed the thread was tied around the GSV. Skin incisions were closed with Steri-strips.The procedure was performed in 20 patients who were scheduled for EVLA for incompetent GS. The mean GSV Diameterat 2 cm distal to the saphenofemoral junction (SFJ) in the standing position, was 5.1&ndash;11.5 mm. The CEAP clinical class was C2&ndash;C5. EVLA and UGHL were performed without complications. The time needed for UGHL was 191&ndash;853 s). UGHL took longer than 360 s (6 min) in 4 patients in the first 10 cases and in 1 patient in the last 10 cases. In the case with a deeply located GSV, encircling of the GSV was fairly difficult, and surrounding tissue could be caught during ligation. Successful GSV ligation was immediately confirmed by US. The postoperative courses were uneventful in all cases.

Less Invasive Ultrasonography-Guided High Ligation of Great Saphenous Vein in Endovenous Laser Ablation

endovenous heat-induced thrombosis (EHIT) and great saphenous vein (GSV) recanalization. To eliminate these complications, we developed ultrasonographyguided high ligation (UGHL) using a puncture-sized incision as an adjunct treatment to EVLA. UGHL combined with EVLA was used in 20 patients. The GSV was encircled with 2-0 silk thread at 2 cm distal to the saphenofemoral junction through two incisions of 2-3 mm by using a Deschamps aneurysm needle under ultrasonographic guidance. UGHL was technically feasible in all cases, and no case presented with complications. UGHL may be used in addition to EVLA.

Comparison of Endovenous Laser Treatment for Varicose Veins with High Ligation Using Pulse Mode and without High Ligation Using Continuous Mode and Lower Energy.

To compare two methods of endovenous laser treatment (EVLT) for primary varicose veins of lower extremities: first-EVLT combined with high ligation of great saphenous vein using pulse mode ablation and 12 W laser ; second-EVLT without high ligation and using lower energy (10 W) and continuous mode. Ninety-three limbs of 75 patients were treated by 980 nm diode laser into the great saphenous veins from June, 2003. In the first group of 45 patients, (HL group), we performed a division of the sapheno-femoral junction after high ligation and EVLT was done with a 12 W laser in a pulse mode. In the second group of 30 patients (NL group) EVLT was performed without high ligation with a 10 W laser in a continuous mode using a laser fiber drawing device. Operation time was significantly shorter in the NL group compared to the HL group (p < 0.05), and the early occlusion rates were 100% (HL group) and 97% (NL group). Subcutaneous bleeding occurred in 9 limbs (16%) in the HL group and 2 limbs (6%) in the NL group. In the NL group there was one case complicated with thrombus which extended into the femoral vein. High ligation at sapheno-femoral junction is not necessary for EVLT and a lower energy continuous mode laser induces a lower rate of complications compared with a pulse mode ablation at a higher energy level. However, close follow-up with duplex scanning is necessary in early postoperative period.

Reply

We did not suggest a very high neovascularization rate after radiofrequency ablation (RFA) of the great saphenous vein. We did discuss a possible connection between what other authors called neovascularization and what we prefer to name small vessel networks. A major reason why we selected small vessel network was to avoid the connotation associated with the concept of neovascularization. Our intention was also to critique the use of the term neovascularization without proof that these vessels did not exist before. For one reason, existing small vessels may dilate in response to an inflammatory process and may constrict after the inflammation subsides. Clinically, thrombosis may occur in the postoperative period in untreated segments proximal and distal to the segment exposed to the RFA and also within the treated segment. Furthermore, patients have complained of localized pain or discomfort starting months after a successful RFA. This localized pain was associated with a visible vein valve sinus either totally thrombosed or partially recanalized; pain was associated with a thrombus that seemed hypoechoic enough to be considered recent. There is growing evidence associating the appearance of small vessels, including arterialized flow, with thrombus. In our articles, we also made the distinction between recanalization and reflux. The term recanalization was preferred to avoid the clinical inference associated with the concept of reflux. At early stages of recanalization, clinical reflux is commonly absent. This recanalization can be temporary and limited in length. (A reason why recanalization was higher in this series than previously reported may be that we considered recanalization segments as short as 1 or 2 cm occurring at any level.) An unstable cycle of thrombosis, inflammation, thrombolysis, recanalization, reduction of inflammation, low-flow condition, and then new thrombosis has been suspected. Eventually the recanalization either becomes wide enough to be part of a local network of small vessels or thrombosis dominates, and, with thrombus aging, the vein segment becomes atretic and atrophic and eventually disappears as such, becoming unrecognizable by ultrasonography. We also have described small vessel networks associated with telangiectasias. It is not surprising to detect small vessel networks in these patients before or after treatment of the saphenous vein. Patients have described the appearance of new telangiectasias after saphenous vein treatment, RFA, or stripping. We have connected the appearance of such new telangiectasias to the small vessels surrounding thrombosed, treated segments of the saphenous vein, mostly large vein valve sinuses. Small vessel networks can also be noted around thrombus inside the canal previously occupied by a stripped saphenous vein. Rather than dismiss the findings of small vessel networks noted after treatment of the saphenous vein, we should investigate whether and when the presence of these channels has a clinical effect. The first step was to recognize the presence of such small vessel networks. Regarding “Ultrasound findings after radiofrequency ablation of the great saphenous vein: Descriptive analysis”Journal of Vascular SurgeryVol. 42Issue 3PreviewIn the recent article by Sergio Salles-Cunha et al,1 the authors suggest a very high neovascularization rate after radiofrequency ablation (RF) of the great saphenous vein (GSV), which does not correspond to our own experience. The authors describe small vessel networks (SVN), which covers without discrimination all vessels smaller than 2 mm in the surrounding tissue of the treated GSV, including muscular, collateral, and tributary veins and their satellite arteries. The high prevalence of these SVN elements in the groin area and at the thigh level is interpreted as the result of a process similar to the neovascularization described after GSV ligation and stripping. Full-Text PDF Open Archive