Ligation Of Saphenofemoral Junction Research Articles

Radiofrequency ablation versus stripping of great saphenous vein in the management of varicose veins

Background: Varicose veins are defined as dilated, tortuous subdermal veins >3 mm in diameter. It is a common entity affecting an estimated 10% of population. Aims and Objectives: The aim was to compare the efficacy of radiofrequency ablation (RFA) with great saphenous vein (GSV) stripping in patients with lower limb varicose veins in terms of disappearance of visible varicosities. Materials and Methods: It was a prospective randomized controlled study, conducted in a tertiary care medical college with the study population consisting of patients suffering from varicose veins. Totally 30 patients were enrolled and divided into 2 groups of 15 patients each. Group A underwent RFA while Group B underwent stripping of GSV with flush ligation of saphenofemoral junction. Results: The mean duration of the procedure in Group A was 53.67±6.6 min while in Group B it was 101.4±11.85 min which was statistically significant (P<0.0001). The mean duration of return to routine activities and work was 2.2±0.41 days in Group A and 3.07±1.16 days in Group B which was statistically significant (P=0.024). Post-operative analgesic requirement was similar in both groups (P=0.224). Complete remission was observed in all patients at 12 months visit and there was no recurrence identified even after a follow-up period of 4 years. Conclusion: RFA was found to be as effective as stripping of GSV in terms of obliteration of veins. The duration of procedure was found to be much less in RFA. Furthermore, cosmetic results, ulcer healing and patient satisfaction rate was better in RFA group. Patient return to normal activity was significantly earlier in RFA group.

Mechanochemical Ablation: Current Status in the Management of Varicose Veins: A Comprehensive Review

Varicose veins, a common venous disorder, often lead to significant discomfort and a reduced quality of life. Over the years, numerous treatment approaches have been explored to alleviate the associated symptoms. Surgical interventions such as saphenofemoral junction ligation and Great Saphenous Vein (GSV) stripping were transformative in their time, but the emergence of endovenous techniques like Endovenous Laser Therapy (EVLT) and Radiofrequency Ablation (RFA) marked a significant shift. While these endovenous techniques have shown exceptional clinical outcomes and cost-effectiveness, they do come with the drawback of pain due to the application of heat for ablation and the necessity of infiltrating tumescent anaesthesia around the vein. In recent years, non thermal, non tumescent methods have arisen as effective alternatives that reduce patient discomfort. These methods encompass procedures such as Mechanochemical Ablation (MOCA) and endovenous cyanoacrylate glue, which minimise heat generation and eliminate the need for tumescent anaesthesia. This article provides a comprehensive overview of the current status of MOCA. It covers its mechanism of action, clinical outcomes, cost-effectiveness, and safety profiles in managing varicose veins.

The first meta-analysis research on the effects of endovenous laser ablation combined with sapheno-femoral junction high ligation of the great saphenous vein.

Endovenous laser ablation (EVLA) is a common minimally invasive technique used to treat varicose veins. The most commonly used laser wavelengths for EVLA/EVLT of varicose veins are 810 nm and 1470 nm. The laser pulse frequency is typically set to continuous wave (CW) mode, with a pulse duration of a few milliseconds (ms) delivered in a radial mode. The energy delivered per pulse is typically set between 40 and 120 Joules, with a power setting of 10 to 30 watts and an intensity setting of 40 to 120 J/cm2. The controversy exists regarding the benefits of performing saphenofemoral junction (SFJ) ligation prior to EVLA to decrease the recurrence rate of varicose veins. This meta-analysis aims to investigate the effectiveness of combining EVLA with high ligation versus using EVLA alone in treating lower extremity varicose veins. We conducted a systematic search of four databases from their inception until July 1, 2022, for randomized controlled trials and prospective controlled trials evaluating the advantages and disadvantages of EVLA with or without high ligation for the treatment of lower extremity varicose veins. In analyzing binary data, rate difference (RD) is used, while odds ratio (OR) is used for evaluating the confidence interval (CI) of binary data. A P value of less than 0.05 is deemed statistically significant. Heterogeneity is assessed using the chi-square test. If the I2 statistic, which reflects statistical heterogeneity, is greater than 50%, a random-effects model should be used. In the absence of significant statistical heterogeneity, a fixed-effects model should be used if I2 is less than 50%. We used the Cochrane risk-of-bias tool to assess the quality of the studies and Review Manager 5.4 for the primary and secondary outcome analysis. The meta-analysis was conducted in accordance with the Cochrane Handbook. There were no significant differences in the rate of major complications (RR = 1.63; 95% CI, 0.40-6.69; P = 0.50) or in the frequency of minor complications (RR = 1.07, 95% CI, 0.87-1.31; P = 0.52) between the EVLA with high ligation (EVLA/HL) group and the EVLA group. However, the rate of vein occlusion was significantly lower in the EVLA group than in the EVLA/HL group (RR = 1.06; 95% CI, 1.03-1.09; P = 0.0004). Our meta-analysis indicates that combining EVLA with high ligation provides stable long-term clinical efficacy in treating varicose veins of the lower extremities, although it increases the invasiveness of the surgery. The use of EVLA alone may be less effective in preventing vein occlusion.

A Prospective Study of Comparison between Open Trendelenburg Operation, Radiofrequency Ablation, EVLA, and Glue Technique for the Management of Varicose Veins

Background: Varicose veins are a subset of Chronic Venous disorders, including spider, reticular, varicose, and leg oedema. In our country, varicose veins are common surgical problems most commonly seen in low socio-economic groups and associated with certain occupation(s). Varicose veins have been known to affect the quality of life (QoL) leading to changes in occupation. Surgical treatment methods such as Saphenofemoral Junction (SFJ) Ligation and Great Saphenous Vein (GSV) stripping with spinal or general anaesthesia, Radio Frequency Ablation (RFA), Endovascular Laser Ablation (EVLA) and GLUE Technique within the operating room are considered in patients who remain refractory to conservative management and continue being symptomatic. Aim & Objectives: The study aimed to compare the outcome and associated post-operative complications, including Deep Venous Thrombosis, Pulmonary Embolism or Paresthesia, and Ecchymosis, with various modalities in the management of varicose veins. Material and Methods: The study was performed at a tertiary care centre which included 200 patients over a period of one year and was evaluated in the basis of VCSS & VDS scores. Results: We observed that all treatment protocols demonstrated results which improved the general physical condition of patients with the least number of complications. Treatment for varicose veins encompasses open surgeries and Endovenous techniques (EVLA and RFA), which show comparative results in clinical improvement, complications and postoperative hospital stay. Both VCSS and VDS are sensitive tools for measuring clinical outcomes of treatments of venous disease. However, the choice of appropriate tool is dependent upon the type of treatment, the Surgeon ‘s personal experience, availability of resources, durations of hospital admission and cost of treatment.

Management of a giant lymphocele following varicose vein surgery: a case report

BackgroundA lymphocele or lymphocyst is formed when lymphatic fluid accumulates in a space, following disruption of lymphatic channels. Here, we report a case of a giant lymphocele in a middle-aged female, who underwent Trendelenburg operation (saphenofemoral junction ligation) for varicose veins of her right lower limb.Case presentationA 48-year-old Pakistani Punjabi female presented to the plastic surgery outpatient department with a history of painful, progressive swelling of the right groin and medial aspect of the right thigh for 4 months. After investigation, it was diagnosed as a giant lymphocele. A pedicled gracilis muscle flap was used to reconstruct and obliterate the cavity. There was no recurrence of the swelling.ConclusionLymphocele is a common complication after extensive vascular surgeries. In the unfortunate case of its development, prompt intervention must be done to prevent its growth and ensuing complications.

Comparative study on outcome of surgical management of varicose veins with and without great saphenous vein stripping

Background: Varicose veins of lower limb are multiple elongated dilated and tortuous veins. It is a progressive disease that worsens as the day passes. The treatment modalities available are conservative, surgical and endovenous therapies. It is accepted that surgical treatment is required for symptomatic varicose veins, to relieve symptoms and to prevent the long-term sequelae of eczema, lipodermatosclerosis and venous ulceration. Different surgical interventions may be used, but most preferred treatment applied is saphenofemoral flush ligation and ligation of incompetent perforators. Methods: This prospective comparative study was conducted on 60 patients in the department of general surgery, Mamata general hospital from July 2020 to June 2022. 60 patients were allocated into two groups of 30 patients each, who underwent flush ligation of saphenofemoral junction with stripping of long saphenous varicose vein and Trendelenburg surgery alone (flush ligation of sapheno femoral junction) respectively. Results: The hematoma formation in the thigh was seen in 23.33% of patients who underwent venous stripping whereas it was seen only in 3.33% who underwent Trendelenburg procedure alone. These wounds were examined in the postoperative period. Delayed wound healing was observed in 26.66% in patients with venous stripping and it was 10% with Trendelenburg procedure alone. There was no significant difference in postoperative ambulation, hospital stay and pain relief after 2 months. Conclusions: From this study with the observed variables, it is concluded that the Trendelenburg procedure with incompetent perforators ligation without venous stripping appears to be better than Trendelenburg procedure with incompetent perforators ligation with venous stripping.

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.

Varicose veins: our experience in KVG Medical College and Hospital, Karnataka

Background: The varicose veins is the most common vascular disorder of the lower extremities. It affects more than 5% of adult population but in India incidence of varicose veins seems to be far less common because patients come for complications such as pain, oedema, pigmentation and ulceration leading to tip of Iceberg phenomenon. This study will help in finding epidemiology, mode of presentation and effect of surgery on venous ulcers and recurrence. The aims and objectives of the study was to study the incidence of varicose veins according to age, sex and occupation with spectrum of clinical presentation in varicose veins. To determine effect of surgery in healing of varicose ulcers if present and study of recurrence upto 6 months.Methods: This prospective study involved 50 patients admitted in KVG Medical College and Hospital, Sullia with clinical diagnosis of varicose veins. The study period was 18 months inclusive of a 6 month follow up period.Results: Most patients was between 41 to 50 years (26 %.), males (74%), left side involvement in (70%) and farmer by occupation (40%) with pain as most common presenting symptom in (76%). Long saphenous system involvement in (94%). 6 patients out of 50 showed recurrence of varicose veins. 4 patient showed recurrence out of 21 venous ulcer patients.Conclusions: For varicose veins saphenofemoral junction ligation with stripping of vein with perforator ligation showed good outcome. Venous ulcers heal well after surgery with few recurrences.

A COMPARATIVE STUDY OF TRENDELENBURG OPERATION AND TRENDELENBURG OPERATION COMBINED WITH STRIPPING OF LONG SAPHENOUS VEIN IN THE TREATMENT OF PRIMARY VARICOSE VEINS OF LOWER LIMB

Aims And Objectives: To compare the effectiveness, incidence of complications and recurrence after Trendelenburg operation and Trendelenburg operation combined with stripping of the thigh segment of long saphenous vein in the treatment of primary varicose veins of lower limb. Study is based on analysis Material & Methods: of 100 cases of primary varicose veins of long saphenous vein with or without perforator incompetence who got treated by either simple ligation or ligation with stripping of long saphenous vein from at Department of General Surgery, Osmania General Hospital, Hyderabad Telangana. After surgery residual long Results: saphenous vein reux was present in 22% cases in the group in which ligation alone was done and residual thigh perforators were identied in 11% of cases whereas in the group which underwent ligation combined with stripping of the thigh segment of long saphenous vein residual reux was present in 6% cases and no residual thigh perforators were identied. The i Conclusion: ncidence of Residual long saphenous vein reex and residual perforator in the thigh is less after ligation and stripping of long saphenous vein compared to Ligation of Saphenofemoral junction alone. The incidence of Nerve palsy and bleeding and hematoma is also not more in the ligation + stripping group compared to ligation alone.

Intermittent pneumatic compression after varicose vein surgery

ObjectiveIntermittent pneumatic compression (IPC) is an established treatment option to remove tissue fluid from patients with lymphedema and chronic venous disease. The effects of IPC applied directly after varicose vein surgery performed with high volumes of tumescent local anesthesia have not been investigated. The aim of the present study was to evaluate the use of postoperative IPC concerning its effects on the leg volume and patient comfort after surgery. MethodsWe performed an investigator-initiated, single-center, open-label randomized controlled trial. A total of 186 patients indicated for saphenofemoral junction ligation and great saphenous vein or anterior accessory saphenous vein stripping or great saphenous vein redo surgery were randomly assigned 1:1 to the intervention or control group. The patients in the intervention group were treated with IPC at 40 mm Hg for 45 minutes directly after surgery. The outcome measures were the leg volume changes calculated using an optical three-dimensional scanning system (primary objective), quality of life (QoL; Freiburg Life Quality Assessment for chronic venous disease, short form), pain, and extent of ecchymosis with follow-up examinations on days 1 and 7 after surgery. ResultsThe patients in both groups had comparable mean leg volume reductions from baseline to day 1 (IPC group, 58.8 mL; control group, 37.4 mL; P = .967) and to day 7 (63.1 mL and 57.0 mL, respectively; P = .546). We also did not observe significant differences between the two groups in QoL and pain. The patients in the IPC group had developed larger areas of ecchymosis compared with the control group (16% vs 13.3% of leg surface, respectively; P = .046), with a tendency toward an increase in pain at 7 days after surgery compared with no IPC application. ConclusionsThe present randomized controlled trial was designed to evaluate the decongestive effects of a single postoperative session of IPC and its effect on QoL, pain, and ecchymosis in patients who had undergone varicose vein surgery under tumescent local anesthesia. Because no evidence for a benefit from IPC could be found in the present study and increased ecchymosis was found, its standard use after varicose vein surgery cannot be recommended.

The outcome of the Trendelenburg procedure with stripping vs. no stripping in the management of varicose veins

Background: Varicose veins is a common problem in Pakistan with multiple treatment options. One of its recommended and commonly performed surgical treatment includes the flush ligation of Saphenofemoral junction (Trendelenburg procedure) with stripping of great saphenous vein and avulsion of varicosities which is a cumbersome process. This study aims to evaluate the effect of stripping of great saphenous vein on the recurrence rate.
 Patients and methods: A randomized controlled trial was conducted in the Surgical Unit I, Services Hospital, Lahore over a period of 22 months from 20-09-2016 to 20-07-2018. Seventy patients were divided equally into two groups of 35 patients each i.e. Trendelenbrug procedure and avulsion of varicosities with stripping down to the knee, (Group A) versus Trendelenbrug procedure and avulsion of varicosities without stripping (Group B). Recurrence at 12 weeks was noted. SPSS version 17.0 was used to analyze data. Comparison of recurrence and stratified confounding factors such as age, gender, and BMI were assessed by the chi-square test (significant p-valve ≤0.05).
 Results: In group A, 32 out of 35 patients were male (91.43%) and 3 (8.57%) were female. While in group B, 31 out of 35 patients were male (88.87%) and 4 (11.43%) were female. Four out of 35 (11.43%) patients in group A whereas 6 (17.14%) group B patients (p-value=0.494) had a recurrence in the perforators below the knee at 12 weeks. Stratification (p-values) of recurrence rate with respect to age (<40 years: 0.41 versus ≥ 40 years:0.905), gender (female: p-value not applicable versus male: 0.96) and BMI was done (<25 kg/m2: 0.36 versus ≥ 25 kg/m2: 0.901)
 Conclusions: Stripping does not significantly affect the outcome of varicose vein surgery in relation to the recurrence rate at 12 weeks and recurrence was independent of age, gender, and BMI of patients.

Correction to: Randomized Controlled Clinical Trial of Sclerotherapy Alone Versus Sclerotherapy Plus Saphenofemoral Junction Ligation in Great Saphenous Varicose Vein

The article “Randomized Controlled Clinical Trial of Sclerotherapy Alone Versus Sclerotherapy Plus Saphenofemoral Junction Ligation in Great Saphenous Varicose Vein”.

Randomized Controlled Clinical Trial of Sclerotherapy Alone Versus Sclerotherapy Plus Saphenofemoral Junction Ligation in Great Saphenous Varicose Vein

Varicose veins are a common presentation, and its treatment has been a challenge for surgeons. Many studies have evaluated the efficacy of foam sclerotherapy with a high failure rate. One of the postulated reasons is inadequate obliteration of saphenofemoral junction with foam sclerotherapy. To test this hypothesis we compared whether there is a decrease in reflux with saphenofemoral junction ligation, along with foam sclerotherapy. Forty-eight patients (50 legs) with primary varicosities of the Great saphenous vein system were randomized into two groups: saphenofemoral junction ligation with foam sclerotherapy (SFJL + FS) and foam sclerotherapy alone (FS), and followed up at 2 months. There was complete disappearance of varicose veins in great saphenous vein territory in 96% of patients in SFJL + FS group, and 88% of patients in FS group. Veins ≥ 8 mm in diameter were incompletely occluded with sclerotherapy. Patient satisfaction score was comparable in both the groups. The addition of saphenofemoral junction ligation to foam sclerotherapy offers no additional patient benefit, particularly with regard to disappearance of varicose veins, relief of symptoms, recurrence, and morbidity. However, in large diameter veins (≥ 8 mm), saphenofemoral junction ligation with foam sclerotherapy gives better results.

Four-year Duplex Ultrasound Follow-up of Trunk Incompetent Saphenous Veins Treated with High Ligation and Reversed Catheter-directed Foam Sclerotherapy

Introduction: Ultrasound-guided foam sclerotherapy (UGFS) is an alternative and supplementary method for endovenous thermal ablation (EVTA) to treat incompetent saphenous reflux (ISR) and branch varicose veins (BVV).[1] The long-term result is not as satisfactory as EVTA, even while administered by catheter-directed method with or without tumescent local anesthesia.[2,3,4] Combined high ligation(HS) of sapheno-femoral junction(SFJ)/ sapheno-popliteal junction (SPJ) and reversed catheter-directed foam sclerotherapy (rCDFS) to treat ISR is an idea to assure SFJ/SPJ closure, avoid foam leaking into deep vein and enhance foam-endothelium interaction to improve safety and surgical results in less invasive and lower cost way. Midterm sonographic changes of target saphenous veins (TSV), clinical severity improvement and re-intervention rate are our concerns. Methods: From Jan. 2015 to Nov. 2018, 37 patients, 38 limbs treated with HS+rCDFS were retrospectively reviewed. The TSVs, CEAP severity, life quality scores, presence of venous leg ulcers (VLU), previous procedures for ISR or BVV, ongoing surgical procedures and following procedures were recorded. All enrolled patients were called back for re-evaluation of CEAP severity, life quality scores and VLU healing. The sonographic changes of TSV and BVV were focused. Results: 37 patients, 70.3% female, aged 29-85(mean 62.4), received HS+rCDFS because of unsatisfactory results of previous interventions (UGFS 21%, others 22.2%) or reluctant to EVTA. The severity above C4a was 76.3% (figure 1), including 26.3% with VLU. The TSVs included 30 great saphenous veins(GSV), 1 anterior accessory great saphenous vein (AAGSV) and 7 small saphenous veins (SSV). 71.1% surgeries were proceeded under local anesthesia. 23.7% surgeries combined with miniphlebectomy and 28.9% with sclerotherapy to BVV and 10.5% with sclerotherapy to reticular/spider veins. 63.2% patients needed following sclerotherapy, 18.4% needed following miniphlebectomy. 70.3% patients were followed from 57 to 1316 (mean 248) days. 76.9% TSVs were fibrotic or sealed. There were 4 small caliber recanalization, 1 large caliber recanalization(LCR), 1 neovasculization and 1 collateralization.(table 1) The VLU healing rate was 100%. The mean AVVQ and VCSS were 2.4, 1.9 respectively. There was one re-intervention for LCR with 1% polidocanol microfoam, Varithena. Conclusion: The severity of this series of patients was high but HS+rCDFS still permitted satisfactory midterm results to treat de novo or relapsed ISR and BVV and achieved 100% VLU healing, not inferior to EVTA or open saphenous vein stripping. The follow-up sonographic findings were surprisingly well without evident neovasculization as expected. Only 4% significant collateralization or LCR might need re-intervention. Disclosure: Nothing to disclose

Ultrasound-based topographic analysis of tributary vein connection with the saphenous vein during ambulatory conservative hemodynamic correction of chronic venous insufficiency

ObjectivePreoperative mapping of great saphenous vein (GSV) escape points to tributary veins (TVs) and targeted intervention of escape points may reduce recurrence rates of varicose veins (VVs) after endovascular treatment of saphenous veins and prevent saphenous nerve complications. The aim of this study was to perform an analysis of cartography after Doppler ultrasound mapping of escape points in patients with VVs and to suggest one point that may prevent recurrence and nerve complications. MethodsUltrasound assessment of VVs was performed from March 4, 2016, to July 15, 2016, specifically focusing on the locations of escape points from the saphenous vein to TVs. The collected data were reviewed retrospectively. The topographic distribution of escape points was as follows: from inguinal ligament to midthigh; from midthigh to knee; from knee to midcalf; and from midcalf to heel. ResultsThirty patients (41 legs) with VVs underwent ultrasound examination. All VVs were characterized by reflux at the GSV. Topographic analysis revealed a total of 79 escape points in all patients. The most common location for escape points was the third part of the leg (from knee to midcalf), where 65.8% of escape points were located; 82.3% of all escape points were located below the knee. The mean diameter of the GSV at 3 cm and 15 cm from the saphenofemoral junction was 6.8 ± 1.6 cm and 5.5 ± 1.5 cm, respectively. Mean diameter of TVs was 5.1 ± 1.9 cm. The diameter was not significantly different between saphenous veins and TVs. The mean number of escape points in each leg was 1.9 ± 1.0. ConclusionsMost escape points (65.8%) are located from knee to midcalf (third part of the leg), and 82.3% of all escape points are located below the knee. The diameter of TVs near the escape point is about 90% of that of the GSV. Thermal ablations of below-knee saphenous vein have potential nerve damage. Ablation of saphenous veins above the knee alone may result in residual shunting and formation of persistent reservoirs in TVs. These persistent reservoirs may be removed effectively with sclerotherapy or miniphlebectomy, especially trying to remove TVs near the escape point. Direct ligation of a TV near the escape point from the saphenous vein, just like saphenofemoral junction ligation, could be performed. These approaches may be able to prevent residual shunting and may reduce recurrence rates and nerve injury.

Use of a Novel Measure of Nontechnical Skills in Surgical Trainees: Is There an Association With Technical Skills Performance?

To investigate whether scores on a psychological measure of concentration and interpersonal characteristics, The Attentional and Interpersonal Style Inventory (TAIS), are associated with performance of surgical skills. Postgraduate surgical trainees completed an operative surgical skills assessment in the simulation laboratory and the psychological measure (TAIS). The surgical skills assessment consisted of 6 tasks (3 per trainee): laceration suturing; lipoma excision; incisionand closure of a laparotomy wound; bowel anastomosis; saphenofemoral junction ligation and basic laparoscopic skills. The association between operative surgical skill performance and TAIS factors was investigated. The TAIS assessments and surgical skills assessments were conducted at the National Surgical Training Centre at the Royal College of Surgeons in Ireland (RCSI). One hundred and two surgical trainees in years one and two (PGY 2-3 equivalent) participated in the study. Performance on 2 of the 6 tasks assessed (bowel anastomosis and lipoma excision) were positively associated with multiple TAIS factors (energy, confidence, competitiveness, extroversion, self-criticism and performing under pressure). Another factor, focus over time, was significantly associated with scores on the lipoma excision task. Trainees with high levels of energy, confidence, competitiveness, extroversion, and focus over time and low levels of self-criticism demonstrated better performance on specific technical skills tasks.

Foam Sclerotherapy and Laser Ablation of Varicose Veins: Newer Option in Bangladesh Perspective

Background: Varicose vein is one of the most common vascular conditions in the adult population. These are conventionally treated with surgical high ligation of Sapheno-femoral junction and stripping of Great Saphenous Vein (GSV) with multiple phlebectomy. The aim of this study was to highlight the technical considerations in performing endovenous laser ablation of varicose vein, understanding the importance and role of Duplex Machine and Tumescent anesthesia with evaluation of outcome.Methods: In this retrospective study we examined the records of 297 limbs of 220 patients operated at Vascular Care Centre at Dhaka, Bangladesh between October 2013 and October 2015. Among them 1 year follow up was performed in 118 patients. Patients were contacted through telephone calls and mobile SMSs with requests for follow up.Results: Vast majority of the patients had a smooth recovery. Significant pain was present in only 10% of patients for 1week after laser therapy and 3% of patients noted bruising in thigh for 2 weeks. Among the 118 patients who reported for follow up at 12 months, 113 (96%) showed effective persistent occlusion of GSV.Conclusion: EVLA of varicose vein is gaining popularity day by day in Bangladesh. It has become established as a safe and effective treatment option for varicosities caused by GSV incompetence. Foam sclerotherapy with Sodium tetradecyl sulphate replacing the multiple phlebectomy may be a suitable adjunct. Quick return to normal activities, fewer wound infections, less leg pain and leg bruising are strongly associated with these endovenous techniques compared with Saphenous vein stripping.Cardiovasc. j. 2018; 10(2): 140-144

The sapheno femoral junction involvement in the treatment of varicose veins disease

Sapheno femoral junction (SFJ) incompetence has been considered the most important cause of chronic venous insufficiency in a high percent of cases since the beginning of history varicose veins treatment. As a consequence SFJ dissection, ligation and section has been practiced all along the last century, generally associated to great saphenous vein stripping, with the porpoise of stopping the effect of hydrostatic pressure considered the origin of varicose veins. Recurrence prevalence at the site of SFJ, even in correctly performed dissection suggests that this attitude may not be the ideal one. Moreover, with the introduction of catheter-based systems of endovenous heating of the great saphenous vein with radiofrequency or endovenous laser ablation, it was shown that venous ablation could be achieved without high ligation of the SFJ. Also foam sclerotherapy demonstrated good results, even if less effective, always leaving the SFJ untouched. Following this trend several methods have been suggested that spare the SFJ, so that this site have lost its strategical importance. In this review history of the SFJ involvement in the varicose vein strategy is analyzed with particular attention to the new generation methods, technology assisted, launched on the market.

AYURVEDIC MANAGEMENT OF VARICOSE VEIN AND VARICOSE ULCER

Vein is said to be varicose when it i s dilated, tortuous and elongated. It appears commonly in long standing people like police, d rivers and rickshaw pullers , older people and obese. Varicose ulcer is clinical manifestation of chronic venous insufficiency. The pathogenesis starts w ith dysfunction of venous valves causing venous hypertension which stretches the vein s resulting in ulce r formation. In modern , conservatively advise stocking, foot end elevation and Heparin medicatio ns. The laksh ana of sirag ranthi and dush ta v r a na mentioned by Acharya Vaghbat and Sushrutas resembles varicose vein and venous ulcer respectively. Mainly siramo kshan, shodhan and ropan are its prime treatment modalities. Surgical modelities involve saphenofemoral junction ligation and greater saph enous stripping and saphenopopliteal junction ligature and lesser saphenous stripping, sclerotheoraphy, subfascial lig ation of Cockett and Dodd split skin graft, r adical surgical approach and bypass surgery. S o treatment modalities mentioned in classics need to be followed to avoid the surgery complications.

Significance of Reflux Abolition at the Saphenofemoral Junction in Connection with Stripping and Ablative Methods.

Saphenous reflux interferes with the physiological decrease in pressure and induces ambulatory venous hypertension. Elimination of reflux is achieved by flush ligation at the incompetent saphenofemoral junction and stripping of the great saphenous vein, which is the basis of the conventional surgical therapy. Endovenous ablative methods substitute stripping by thermal of chemical destruction of the saphenous trunk; they usually refrain from saphenofemoral junction ligation. Short-term and medium-term results up to 5 years, achieved after endovenous ablation without high ligation, are comparable with those after conventional surgery, which questioned the necessity to ligate the incompetent saphenofemoral junction. Nevertheless, clinical symptoms caused by recurrent reflux occur as a rule not earlier than 8 to 10 years after efficient abolition of reflux. Consequently, randomized studies with long-term follow-ups exceeding 10 years are necessary for trustworthy assessment whether it is justified to abstain from saphenofemoral junction ligation.