Saphenofemoral Ligation Research Articles

Assessing UGFS+SFL as an Alternative to Conventional Surgery for Varicose Veins: Outcomes, Safety, and Economic Implications: A Comparative Study

Objective: The aims of the study is to compare the efficacy, safety, and the cost-effectiveness of ultrasound-guided foam sclerotherapy related with the sapheno-femoral ligation (UGFS+SFL) versus conventional surgical treatment for the varicose veins. Methods: This study was conducted over a period of 18 months. Minimum of 80 patients with primary varicose vein due to SFJ (saphenofemoral junction) incompetence were selected and randomly assigned in each arm i.e. surgical and foam sclerotherapy. Results: Both of UGFS+SFL and the conventional surgery led to the significant improvements in CEAP and the VCSS scores. UGFS+SFL group showed the greater reduction in VCSS scores post-treatment compared to surgical group. The Early complications were fewer in UGFS+SFL group, which had no cases of deep the vein thrombosis (DVT) or saphenous nerve injury, the unlike surgical group. Cost of UGFS+SFL was Rs.255924, the significantly lower than Rs.425644 for conventional surgery. The Ultrasound follow-up revealed high rates of vein obliteration in the both groups, though UGFS+SFL group had slightly the lower rates of full obliteration at 3 months. Conclusion: The UGFS+SFL is an effective and the cost-effective alternative to conventional surgery for treating the varicose veins. It offers the comparable clinical outcomes with fewer complications and the lower costs. These treatments achieve high rates of the vein obliteration, making UGFS+SFL a viable option for patients seeking the less invasive approach

Quality of Life in Patients Undergoing Endovenous Laser Ablation and Saphenofemoral Ligation and Stripping

Introduction: Surgery for varicose veins was the treatment of choice before the advent of minimally invasive procedures. Aim: This study was done to compare the utility of endovenous laser ablation (EVLA) as an effective alternative to surgery to treat varicose veins. Materials and Methods: The study was conducted in a tertiary care hospital between October 2019 and March 2021. One hundred and six patients with varicose veins of the long saphenous system were included in the study, 53 in the laser surgery group and 53 in the open surgery group. European Quality of life 5 dimensions questionnaire, the WHO VAS score and clinical aetiological, anatomical and pathological classification for varicose veins scores of the affected limb of the patients were recorded preoperatively and postoperatively at day 90. Data were statistically analysed using SPSS. Results: Patients treated by EVLA enjoyed a better quality of life than the ligation and stripping group. They experience significant reduction in the post-operative pain, the absence of wound infection and a significant reduction in the clinical severity scores. Conclusion: EVLA is a safer and effective means for treating varicose veins.

Ten-year follow-up of a randomized controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia

ObjectiveThe long-term results of saphenofemoral ligation and stripping (SFL/S) were compared with 980-nm bare fiber endovenous laser ablation (EVLA) for the treatment of great saphenous vein (GSV) incompetence. MethodsThis was a single-center, randomized, controlled trial with a follow-up time of 10 years. Patients with GSV incompetence were randomized to undergo SFL/S or EVLA under tumescent anesthesia. The primary outcome was recurrence of groin-related varicose veins seen on duplex ultrasound imaging and clinical examination. The secondary outcomes were (changes or improvement in) CEAP clinical class, venous symptoms, cosmetic results, quality of life, reinterventions, and complications. ResultsBetween June 2007 and December 2008, 122 patients (130 limbs) were included; of these, 68 limbs were treated with SFL/S and 62 limbs with EVLA. The 10-year estimated freedom from groin recurrence as seen on duplex ultrasound imaging was higher in the SFL/S group (73% vs 44% in the EVLA group; P = .002), and the same trend was seen for clinically evident recurrence (77% vs 58%, respectively; P = .034). Nine reinterventions (17%) were deemed necessary in the SFL/S group vs 18 (36%) in the EVLA group (P = .059). All reinterventions in the SFL/S group consisted of foam sclerotherapy. Reinterventions in the EVLA group included foam sclerotherapy (n = 5), crossectomy (n = 2), and endovenous procedures (n = 11). There was no significant differences in quality of life and relief of venous symptoms. Cosmetic appearance improved, with a better cosmetic rating in the SFL/S group compared with the EVLA group (P = .026). One patient in the SFL/S group had a persisting neurosensory deficit remaining at 10 years. ConclusionsThis study showed no clear long-term advantage of EVLA with a 980-nm wavelength and bare-tip fiber over high ligation and stripping of the GSV under local tumescent anesthesia.

Ten-Year Follow-up of a Randomized, Controlled Trial Comparing Saphenofemoral Ligation and Stripping of the Great Saphenous Vein With Endovenous Laser Ablation Using Local Tumescent Anesthesia

Ten-Year Follow-up of a Randomized, Controlled Trial Comparing Saphenofemoral Ligation and Stripping of the Great Saphenous Vein With Endovenous Laser Ablation Using Local Tumescent Anesthesia

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.

Comparison of complications of varicose veins treatment with saphenofemoral ligation and foam sclerotherapy compared to saphenofemoral ligation and stripping

Background: Varicose veins affect 20–30% of adults. If symptoms persist, the main treatment options are sclerotherapy, surgery (usually stripping and ligation of the long or short saphenous veins and phlebectomies), and ablation (by laser or radiofrequency ablation). Present study was aimed to compare the efficacy of treatment of varicose veins with Saphenofemoral ligation and Foam sclerotherapy compared to Saphenofemoral ligation and stripping.

Endovenous Laser Ablation with 1,470-nm Diode with Tumescence Anesthesia and Saphenofemoral Ligation: Propensity Score Match Comparison

The aim of this study is to compare 2 groups of patients treated for great saphenous vein (GSV) reflux with open surgical saphenofemoral ligation (SFL) and endovenous laser ablation (EVLA). Consecutive patients with primary unilateral GSV reflux undergoing EVLA treatment since 2014 were enrolled, and another series of patients treated with SFL was considered. The patients were stratified according to treatment and the results were compared using the propensity score (1:1). The covariables were age, gender, body mass index, CEAP (Clinical class, Etiology,Anatomy and Pathophysiology) staging, and GSV and saphenofemoral junction diameters. Primary outcomes were GSV occlusion or recurrent groin varicose veins at 1 year after treatment. Secondary outcomes included vein thrombosis, hyperpigmentation, paresthesia, postoperative pain, analgesic requirement, and ecchymosis assessed at discharge and CEAP stage and quality of life (QoL) assessment 1 month after surgery. A total of 123 patients were included in the study: 59 were treated with EVLA and 64 with SFL. At 12months, we observed 10 recurrent groin varicose veins after SFL (15.6%) and 6 GSV recanalization after EVLA (10.2%, P=0.369). Extra-saphenous recurrent varicose veins were observed in 36 patients (29.3%): 20 in the open group (31.2%) and 16 in EVLA group (27.1%, P=0.615). After matching procedure 74 patients were analyzed (37 patients by group), logistic regression model showed that the risk of outcome was not associated with the surgical treatment (odds ratio 1.76, 95% confidence interval 0.52-6.01). Both techniques to treat saphenous impairment have demonstrated to be safe, with good results in terms of efficacy and symptomatic improvement at follow-up. EVLA with 1,470nm seems to have lower rates of recurrence and good perceived QoL. Tumescent anesthesia is a good option with good results and may be extended to open surgical ligation.

Foam sclerotherapy combined with saphenofemoral ligation procedure: long-term results

Objective: To evaluate the clinical effect of the foam sclerotherapy combined with saphenofemoral ligation (FS-SFL) in a selected group of patients with varicose disease and present the long-term results of ten-year ultrasonographic follow-up. Methods: Sixty-five patients with primary varicose veins due to the great saphenous vein incompetence who had been treated with FS-SFL were retrospectively reviewed over a period of ten years. The patients were assessed before and after the treatment by Doppler ultrasonography and clinical examination. Results: The mean age of the patients was 44.6 ± 11 years (range: 19 to 87 years), and 51 were females and 14 were males. Follow-up for all patients was ten years. The most common complication was skin pigmentation. There were no major complications. No recanalization of the great saphenous vein was seen in any patient. Conclusions: FS-SFL is a safe and effective method of treating varicose veins. This treatment have a low rate of recanalization in their long-term follow-up.

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.

New Method of Flush Saphenofemoral Ligation that is Expected to Inhibit Varicose Vein Recurrence in the Groin: Flush Ligation Using the Avulsion Technique Method.

Recently, with the spread of laser ablation therapy, it has been called into question whether flush ligation of the great saphenous vein (GSV) reduces varicose vein recurrence after surgery. Because we thought such recurrence was caused by a narrow branch resection area, we developed a new method of flush ligation (the avulsion technique method). Materials and Methods: A total of 214 limbs in 180 patients whose GSV had become varicose were studied. In our procedure, we dissect the GSV, lift its proximal stump, and expose the tributaries. We pull out the distal side of the tributaries without ligature as far as possible. We evaluate the area of subcutaneous ecchymosis within a 15-cm radius of the inguinal incision visually on the third post-operative day. Results: We were able to pull out over 10 cm per branch by this method. The area of subcutaneous ecchymosis was mostly less than 10%. No hematoma or pain was observed after the operation. Conclusion: This method was safe, with subcutaneous ecchymosis occurring only rarely. We expect this method to reduce saphenofemoral junction recurrence after the operation. (This is a translation of Jpn J Phlebol 2017; 28: 11–16.)

Can vein patch interposition after sapheno-femoral ligation prevent postoperative neovascularization at the saphenofemoral junction?

Background: Majority of recurrence of varicose veins following both primary and repeated surgery was attributable to neovascularization. The aim of this study was to evaluate the efficacy and safety of the new natural origin anatomical barrier (vein patch) in decreasing neovascularization after initial surgery.Methods: The study included 50 patients with primary varicose vein and incompetence of SFJ. The patients are divided randomly into 2 groups, group (A) (conventional surgical group) and group (B) (barrier technique group), each one included 25 patients. In group (A) SFJ ligation with ligation of all the tributaries and stripping of great saphenous vein (GSV) in the thigh portion was done. In group (B), after conventional surgical procedure was done vein patch was taken from striped LSV. The vein patch was applied on the cribriform fascia opening. This barrier of vein patch is reinforced by good tight subcutaneous tissue suture.Results: Neovascularization was seen on duplex in 4 (16%) limbs of group (A) conventional surgical group at one year follow up, but in group (B) barrier technique group neovascularization was seen only in one (4%) limb. Groin infection was registered in 3 (12%) limbs, 2 (8%) of them in group (A) conventional surgical group and the third one (4%) in the group (B) barrier technique group.Conclusions: Vein patch interposition after correctly SFJ ligation seems to lower the incidence of neovascularisation after one year. This technique may constitute additional option to prevent recurrence.

Systematic review and meta-analysis of randomized controlled trials evaluating long-term outcomes of endovenous management of lowerextremity varicose veins.

Early studies have demonstrated that endovenous therapy for varicose veins is associated with a faster recovery and lower complication rates compared with conventional therapy. More than one million procedures have been performed worldwide. The objective of this study was to determine long-term efficacy of currently available endovenous therapy methods for varicose veins compared with conventional surgery (saphenofemoral ligation and stripping of great saphenous vein [GSV] with or without multiple avulsions) in management of GSV-related varicose veins. In July 2017, we searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Cochrane Library, and Web of Science without date or language restriction for relevant randomized controlled trials (RCTs). Bibliographies of included studies were also searched for additional studies. RCTs comparing conventional surgery and endovenous therapy for treating lower extremity varicose veins with 5years or more of follow-up were selected. Data extraction and quality assessment were performed independently by two review authors, and any disagreements were resolved by consensus or by arbitration of a third author. Cochrane RevMan 5 was used for analysis. At time of data extraction, long-term follow-up was available for endovenous laser therapy (EVLT), radiofrequency ablation (RFA), and ultrasound-guided foam sclerotherapy. Included in the review were nine RCTs. The RCTs included 2185 legs; however, only 1352 legs were followed up for 5years (61.9%). There was no statically significant difference in recurrence rate in comparing EVLT with conventional surgery in treating GSV incompetence (36.6% vs 33.3%, respectively; pooled risk ratio, 1.35; 95% confidence interval, 0.76-2.37; P= .3). Also, no significant difference was determined for recurrence rate in comparing RFA with surgery or EVLT. Although the analysis showed that EVLT and RFA are as effective as conventional surgery in treating saphenous venous insufficiency, the number of patients available for analysis was too small for definitive conclusions to be drawn.

Chronic venous insufficiency - a review of pathophysiology, diagnosis, and treatment.

Chronic venous disease is a common disorder associated with a variety of symptoms in later disease stages but also with complications such as venous leg ulcer. This, in turn, has substantial socioeconomic effects and significantly impacts patients' quality of life. While there are a number of diagnostic procedures available, color-flow duplex ultrasound has become the gold standard. As regards therapeutic options, major advances have been made in recent decades. Today, there are alternatives to saphenofemoral ligation and stripping of the great saphenous vein, including endovenous thermal ablation techniques. However, treatment selection continues to depend on many factors such as individual anatomical circumstances and disease stage. The following article provides an overview of the anatomy and pathophysiology as well as current diagnostic and therapeutic standards.

New Method of Flush Saphenofemoral Ligation that is Expected to Inhibit Varicose Vein Recurrence in the Groin: Flush Ligation Using the Avulsion Technique Method

New Method of Flush Saphenofemoral Ligation that is Expected to Inhibit Varicose Vein Recurrence in the Groin: Flush Ligation Using the Avulsion Technique Method

Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia

The objective of this study was to compare the long-term results (groin-related recurrence, great saphenous vein [GSV] occlusion rate, Clinical class, Etiology, Anatomy, and Pathophysiology [CEAP] staging, and quality of life [QoL]) after the treatment of a GSV incompetence by saphenofemoral ligation and stripping (SFL/S) with endovenous laser ablation bare fiber, 980 nm (EVLA). Patients with GSV insufficiency and varicose veins were randomized to either undergo SFL/S or EVLA, both of which were performed under tumescent anesthesia. The long-term results, which included the anatomic occlusion rate, varicose vein recurrence at the saphenofemoral junction (SFJ), relief of venous symptoms and QoL, were compared up to 5 years after treatment. A total of 130 legs of 121 patients were treated with either SFL/S (n = 68) or EVLA (n = 62). In the first 12 months, three recanalizations of the GSV were observed after EVLA. Up to 5 years later, more recurrent varicose veins caused by neoreflux in incompetent tributaries of the SFJ were observed in after EVLA (31%; 19/61) compared with SFL/S (7%; 4/60; P < .01). Neovascularization in the groin with clinically visible recurrence identified at 3 and 5 years post-treatment follow-up was only observed in the SFL/S group (n = 6). After 5 years, clinically visible recurrences originating from the SFJ region after EVLA were observed 33% (20/61) compared with 17% of patients (10/60) after SFL/S (P < .04). In both treatment groups, venous symptoms improved significantly. Patients in both groups reported a continuing significant cosmetic improvement measured on a visual analog scale of 1 to 10 (mean, 7.49; P < .01). There was no difference in the CEAP staging and a standardized, non-disease-specific instrument for describing and valuing health states (EuroQol-5D), between the groups up to 5 years after follow-up. At the 5-year follow-up, a significantly higher varicose vein recurrence rate originated at the SFJ region after EVLA compared with SFL/S. There were no differences in the relief of venous symptoms, CEAP staging, or general QoL between the groups.

Neovascularisation is not an innocent bystander in recurrence after great saphenous vein surgery.

This study sought to establish the causes of failure of great saphenous vein surgery among patients in whom there was confidence that accurate saphenofemoral ligation had been carried and the great saphenous vein had been stripped at least to knee level. This was an observational study of 100 limbs (66 patients) operated on by a single surgeon 5-22 years previously (mean: 12 years). The index operation was primary in 54 limbs and for recurrence in 46 limbs. Thirty-two patients were studied having been re-referred for recurrence while 34 were recalled for review. All were examined clinically and with duplex ultrasonography, and all completed questionnaires (Aberdeen varicose vein questionnaire [AVVQ] and EQ-5D-3L). In order to measure the extent of visible recurrence, a scoring system similar to that in the venous clinical severity score was used but with a range of 0-8. There were visible varicosities in 77 of the 100 limbs. Duplex ultrasonography showed that recurrent saphenofemoral incompetence (SFI) was present in 27% of the limbs. This was judged to result from neovascularisation and was the most common source of reflux. AVVQ scores for the 27 limbs with recurrent SFI (median: 34, interquartile range [IQR]: 20-42) were higher than for the 73 with no recurrent SFI (median: 17, IQR: 11-29), which was a significant difference (Mann-Whitney U test, p<0.01). Analysing clinical scores with chi-squared tests indicated fewer visible varicosities in limbs without recurrent SFI than in those with recurrent SFI (p<0.01). Neovascularisation remains poorly understood but it cannot be considered an innocent bystander.

Radiofrequency ablation: an assessment of clinical and cost efficacy.

Varicose veins are common and frequently cause patient distress. In recent years, Radiofrequency ablation (RFA) has emerged as a minimally invasive alternative to traditional open venous ligation surgery. The aim of this study was to directly compare RFA and open saphenofemoral ligation. This was a single-centre retrospective cohort study. Consecutive patients undergoing surgical management over a 2-year period commencing from January 2011 were studied. Radiological success, peri-operative serological testing and hospital length of stay were documented. Procedural cost was calculated. A focused cohort analysis was undertaken to compare the initial 50 RFA procedures performed with the last 50. During the study period, 296 patients underwent surgical intervention. A total of 204 patients underwent RFA. Sixty-six percent of all patients were female. RFA was associated with a reduction in overnight hospital stay (18 vs. 78 %, P = <0.001) when compared with open ligation with a success rate of 98 %. No significant inter-group difference was noted for 30-day readmission (p = 0.203). Focused cohort analysis identified an increase in hospital day case activity (74 vs. 90 %, p = 0.002), which contributed to a reduction in procedural cost (€1,024 vs. €971, p = 0.003) over the study period. Radiofrequency ablation is a viable alternative to open repair offering excellent efficacy. It is however associated with a higher procedural cost than the open surgical option.

Influence of perforating vein surgery in patients with venous ulceration

The exact role of perforating vein surgery is still unclear. The aim of this study is to analyze the influence of perforating vein surgery in patients with venous ulceration. This study was part of a randomized controlled trial in which conservative and surgical treatment of venous ulceration was compared. It is a secondary analysis of prospectively gathered data. Ninety-seven active leg ulcers were surgically treated with a subfascial endoscopic perforating vein surgery (SEPS) procedure. Concomitant superficial venous incompetence was treated with flush saphenopopliteal ligation and/or saphenofemoral ligation and limited stripping of the great saphenous vein. All patients were also treated with ambulatory compression therapy. Ulcer healing and recurrences are described in detail. To measure the completeness of the SEPS procedure duplex ultrasonography was performed on each patient before and 6 weeks and 12 months after surgery. Also newly formed perforators after surgery were scored and their influence was analyzed. Analyses were performed on 94 ulcerated legs with a mean follow-up of 29 months. In all treated legs, only 45% all perforators were treated. In 55% one (29%) or more (26%) perforators were missed. Healing was not significantly influenced by the number of remaining incompetent perforating veins, but recurrence was significantly higher in patients who had incomplete SEPS procedure (p = 0.007 log-rank). New incompetent perforating veins did not affect ulcer healing or recurrence. The plotted location of new perforators did not show a pattern. Deep vein incompetence and treatment of superficial venous incompetence had no significant influence on healing or recurrence rates in a complete or incomplete SEPS procedure. In this series a well-performed SEPS procedure lowers the venous ulcer recurrence rate significantly, indicating the clinical importance of incompetent perforating veins in patients with an active venous ulcer.

Foam Sclerotherapy with Saphenofemoral Ligation Compared to Standard Surgery for Varicose Veins

Foam Sclerotherapy with Saphenofemoral Ligation Compared to Standard Surgery for Varicose Veins

Day-case re-do varicose vein surgery

To assess whether re-do varicose vein surgery as a day case is feasible and safe. Data were collected retrospectively on 70 consecutive patients (77 legs) undergoing re-do sapheno-femoral or sapheno-popliteal ligation by consultant surgeons as day cases. Follow-up was by structured telephone interview. The 70 patients comprised 53 females and 17 males. Median age and body mass index were 47.5 years and 27, respectively. All patients were ASA Grade I or II. Median operating time was 75 min (range 25-140). Of the 70 patients intended to be treated as day cases, four (5.7%) were admitted overnight. There were no were re-admissions nor did any patient develop deep vein thrombosis. Eleven per cent developed wound infection and 4% transient lymphatic leakage. Overall, 91% of patients were pleased with the initial surgical result but this decreased to 81% in the longer term. Eighty-nine per cent would have their surgery performed again as a day case. Re-do sapheno-femoral or sapheno-popliteal can be performed safely as a day case.