Saphenous Vein Stripping Research Articles

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.

Venous Thromboembolism Prophylaxis and Thrombotic Risk Stratification in the Varicose Veins Surgery-Prospective Observational Study.

Background: An invasive phlebological treatment is still not free from complications such as thrombosis. As in other surgical populations, not only the treatment modality, but also patient condition-related venous thromboembolism (VTE) risk factors matter. The current protocols used in varicose vein surgery centers are based mostly on individual risk assessment as well as on an implementation and extrapolation of general surgery VTE prophylaxis guidelines. In the presented study, the efficacy of routine VTE pharmacological thromboprophylaxis in patients undergoing saphenous varicose vein surgery was prospectively evaluated. In the result assessment, VTE risk factor evaluation and Caprini score results were included; however, due to the limited size of the projected study group, as well as expected limited deep vein thrombosis (DVT) prevalence in this clinical scenario, it was not possible to perform the validation of the Caprini model efficacy in the projected study model. Methods: In the study, 141 patients undergoing saphenous vein stripping and miniphlebectomy in spinal anesthesia were included. In all of the patients, VTE risk factors (including Caprini score evaluation) were assessed, and the routine thromboprophylaxis with enoxaparin 40 mg for 10 days was used. The venous ultrasounds were undertaken before the surgery and on the 10th and 30th day after surgery. The study endpoint was the presence of symptomatic or asymptomatic DVT confirmed in the imaging study. The study safety endpoint was major bleeding occurrence intraoperatively or within 30 days after surgery. Results: The presence of a postoperative DVT was diagnosed in five cases (3.5%) In all of these cases, only distal DVT was confirmed. Despite extensive saphenous varicose vein surgery with stripping and miniphlebectomy performed in nontumescent but spinal anesthesia, no proximal lower leg episode was diagnosed. Three out of five DVT cases were diagnosed on day 10 postoperative control, while a further two were confirmed in the ultrasound examination performed 30 days after procedure. No clinically documented pulmonaly embolism (PE) as well as no bleeding episodes were noticed. Among the factors related to the statistically significant higher DVT occurrence, the results of the Caprini score were identified with odds ratio (OR) = 2.04 (95% CI = (0.998; 4.18)). Another factor that became statistically significant in terms of the higher postoperative DVT prevalence was the reported Venous Clinical Severity Score (VCSS) results (OR = 1.98; 95% CI (1.19; 3.26)). In the multiple logistic regression analysis, the patient age (OR = 0.86; 95% CI (0.75–0.99)), Caprini score evaluation results (OR = 4.04; 95% CI (1.26–12.9)) and VCSS results (OR = 2.4; 95% CI (1.23–4.7)) were of statistical significance as predictors for postoperative DVT occurrence, with a p value of 0.029 for age, and p = 0.017 and p = 0.009 for Caprini score results and VCSS results, respectively. Due to the confirmed limited number of the DVT events in our study cohort, as well as the descriptive and explorative nature of the achieved results, the final clinical potential and significance of the identified parameters, including Caprini score rate and VCSS rate, should be interpreted with caution and studied in the further trials in these clinical settings. Conclusion: All the patients undergoing varicose vein surgery should undergo VTE risk evaluation based on the individual assessment. In VTE risk evaluation, patient and surgical procedure characteristics based on the factors included into the Caprini score but also on specific chronic venous disease-related factors should be taken into consideration. Further studies are needed to propose an objective and validated VTE risk assessment model, as well as a validated antithrombotic prophylaxis protocol in this particular patient group.

Conservative Hemodynamic Surgery in the Management of Primary Varicosities of the Long Saphenous Vein: Emerging Experience in Suez Canal University Hospital

Background: Contrary to traditional long saphenous vein (LSV) surgeries, stripping and endovenous laser ablation, using heat coagulation, ambulatory conservative hemodynamic correction of venous insufficiency (CHIVA) is LSV sparing technique. Aim: Based on the lack of studies discussing success and recurrence rate, this study was designed to assess the immediate and one-year follow-up of this technique, as well as its efficacy and safety. Patients and Methods: Thirty-three patients with primary LSV varicosities were included in this uncontrolled clinical trial. Patients with LSV diameter of ≥ 9.5mm or pregnancy were excluded. Results: The mean age of our patients was 33.36±8.865 years, and 54.5% of them were males. According to Hobb's score, 25 patients (75.7%) were completely cured, 6 patients (18.1%) were improved, while 2 patients (6.2%) were considered as failure. Most (87.9%) of the patients showed absent or no visible recurrence. The rest showed visible recurrence by duplex ultrasound. All patients had significant improvement of their symptoms (no pain, or edema) at the immediate follow-up after operation. No complication including hematomas, ecchymosis, hemorrhage, saphenous nerve neuralgia, phlebitis, infection, deep or LSV thrombosis was detected. Conclusion: CHIVA is a successful and effective option in managing patients with primary long Saphenous varicosities, with minimal recurrence rate, after one-year of follow-up.

Inferior selective crossectomy for great saphenous vein incompetence: Our experience.

To describe the mid-term outcome after inferior selective crossectomy in a subset of patients with symptomatic chronic venous disease and both great saphenous vein and suprasaphenic valve incompetence.Methodsː Retrospective analysis of prospectively collected data was conducted. During an eight-year period, 1095 ligations of all saphenofemoral junction inferior tributaries and great saphenous vein stripping were performed in 814 Clinical, Etiology, Anatomy, Pathophysiology C2-C6 patients. Duplex ultrasound follow-up examinations were performed after 30 days, 6 months, and 2 years, and saphenofemoral junction hemodynamic patterns and varicose veins recurrence rates were evaluated. Two hundred and twenty patients completed the two-year follow-up period. At the 30-day Duplex ultrasound evaluations, two different hemodynamic patterns were described. Type 1, with physiological drainage of saphenofemoral junction superior tributaries, was observed in 214 patients. Type 2, without flow in saphenofemoral junction superior tributaries, was observed in six patients. Overall varicose vein recurrence rates were 0, 2.3, and 2.7% at the 30-day, 6-month, and 2-year follow-up examinations, respectively. At the two-year follow-up, Type 1 patients showed 0% varicose vein recurrence, while Type 2 patients showed 100%.Conclusionsː Inferior selective crossectomy seems to be a valid and safe option in case of both suprasaphenic valve and great saphenous vein incompetence. Duplex ultrasound evaluation, according to our protocol, allows us to identify two different saphenofemoral junction hemodynamic patterns that could predict varicose vein recurrence at mid-term. An optimal stump washing after inferior selective crossectomy, warranted by patency and large caliber saphenofemoral junction superior tributaries, seems to be the key point in preventing varicose vein recurrence in this context. However, large prospective studies regarding saphenofemoral junction modifications and varicose vein recurrence are needed to confirm these preliminary observations.

Randomised controlled study to compare radiofrequency ablation with minimally invasive ultrasound-guided non-flush ligation and stripping of great saphenous vein in the treatment of varicose veins.

Flush ligation at the saphenofemoral junction and stripping of the great saphenous vein is being increasingly replaced by endovenous methods such as radiofrequency or endovenous laser ablation for the treatment of varicose veins. These modalities are expensive and not widely available. A minimally invasive ultrasound-guided surgery with non-flush ligation and stripping under local anaesthesia is a cost-effective alternative with similar postoperative outcomes. A total of 62 limbs (58 patients) with saphenofemoral junction incompetence underwent clinical evaluation including the CEAP clinical score, the venous clinical severity score, the venous disability score and venous doppler. Patients were randomly assigned to either group A (radiofrequency ablation) or group B (ultrasound-guided non-flush ligation and stripping of the great saphenous vein) for procedures under tumescent anaesthesia and ultrasound guidance. Patients were followed-up on days 7, 30 and 90 to assess primary (obliteration rates) and secondary (venous clinical severity score and venous disability score) outcomes. Both the groups showed 100% obliteration of the great saphenous vein at day 90. The venous clinical severity and venous disability scores significantly improved from day 0 to day 90 in both groups (p = 0.0001). There were no major complications. Group A showed significantly lower minor complications (p = 0.001). None required conversation to general anaesthesia. The ultrasound-guided non-flush ligation and stripping of the great saphenous vein are as efficacious as radio frequency ablation, with similar obliteration rates, improvement in disability scores and complication profile at a lower cost. It has the potential for wider availability in the community as most surgeons are conversant with the surgical procedure.

Comparative Study between Conventional Surgery, Endovenous Laser Ablation and Saphenofemoral Disconnection with Endovenous Chemical Ablation for Treatment of Lower Limbs Varicose Veins

Background: Chronic venous disease is the most common disorders of the peripheral vascular system. Endovenous , open surgery or hybrid ttt for varicose veins is commonly performed for treatment of primary VV. Objective: To evaluate safety and efficacy of triple saphenectomy, Endovenous laser ablation (EVLA) and Endovenous Chemical Ablation with Trendlenburge operation (eCAT) in comparative study as a methods of treatment of VV. Materials and Methods: 75 patients who had primary VV were included. They randomized into three equal groups each one was 25 patients group1 treated by triple saphenectomy , group 2 treated by EVLA,and group 3 treated by eCAT. 43 patients (57.3%) suffered from Disfigurment , 21 patients (28.0%) suffered from ulcer and 11 (14.7%) suffered from pain. With exclusion of patients with Infected ulcer, chronic deep venous thrombosis, incompetent deep venous system , recent pulmonary embolism. Results: For 75 patients over a period of 2 year of clinical and duplex follow up, 47 patients (62.7%) were done to them operation under spinal anesthesia, 5 (6.6%) under general and 23 (30.7%) under local A. Post-operative pain score decreased in patient treated with laser (group II) (3.15±0.73) and with e CAT (group III) (3.52±0.51) when compared with surgery (group I) (5.88±0.79) with statistical significant differences. Conclusion: Ablations may replace saphenous vein stripping and phlebectomy which as a single procedure without Trendlenberg’s operation may increase the risk of recurrence especially in yong age.eCAT is 1 operation with very low reccurence and it can improve all drawbacks of Convensional Surgery .

A clinical study on varicose veins of lower limb, surgical management and functional outcome at a tertiary care hospital of South India

Background: Varicose veins defined as dilated, tortuous, subcutaneous veins ≥3 mm in diameter, measured in the upright position with demonstrable reflux. Though the history of varicose veins dates prehistorically, the advances in diagnosis and new management modalities gained attention recently. The aim of the present study was to study the clinical profile, risk factors and their association, different types of surgical procedures employed and complications associated with varicose veins.Methods: A one year observational after ethical committee approval was conducted by department of general surgery at ACSR Medical College. Cases fulfilling the inclusion criteria were clinically examined and duplex ultrasound colour Doppler was performed for diagnosing the varicose veins and findings of site of incompetence was noted. All the cases were operated and followed up for six months period. The results were tabulated and analyzed in Microsoft Excel for any corrections.Results: Eighty cases with 66.25% males and 33.75% females with mean age of 40.24 years and majority (40%) were in 41 to 50 years group. 60% of cases had varices in right limb and long saphenous vein was involved in 52.5% of cases.85% had dilated veins, perforator incompetence was noted below the knee in 30% of cases. 41.25% of cases saphenofemoral flush ligation with stripping of long saphenous vein. Wound infection was the common postoperative complication.Conclusions: Operative line of management should be the first line of treatment even though conservative management relieves the symptoms but always requires a definitive management.

Effectiveness of tumescent solution combined with negative pressure wound therapy in traditional high ligation and stripping of the great saphenous vein.

Traditional high ligation and stripping (THLS) is a routine operation for varicose veins. However, THLS is accompanied with postoperative subcutaneous ecchymosis and pain. In this current study, we aimed to explore the effect of tumescence solution (TS) combined with negative pressure wound therapy (NPWT) on the relief of subcutaneous ecchymosis and pain after THLS of great saphenous vein.A total of 180 patients receiving THLS were enrolled in group A, and 120 patients undergoing THLS and TS combined with NPWT were assigned into group B. The occurrences of subcutaneous ecchymosis and pain were recorded. Moreover, the total area of subcutaneous ecchymosis was estimated by the grid method. Visual analogue scale (VAS) score was used to assess the pain level of both groups.Preoperative characteristics were not significantly different between 2 groups. Postoperative ecchymosis occurred in 112 cases (62.2%) of group A and 41 cases (34.2%) of group B. The area of ecchymosis in group A (66.6 ± 44.5) cm2 was larger than that in group B (25.2 ± 19.9) cm2. The number of patients without obvious pain in group A (57, 31.7%) was significantly less than that in group B (77, 64.2%) after operation. In addition, VAS score in group A (3.1 ± 2.6) was higher than that in group B (2.2 ± 1.9).In conclusion, the application of TS combined with NPWT in THLS can not only alleviate subcutaneous ecchymosis and pain, but also prevent the occurrence of subcutaneous ecchymosis and pain after operation. Therefore, it is conducive to postoperative recovery and is suitable for clinical application.

A malpractice: Stripping of the great saphenous vein without the division of the side-branches at the saphenofemoral junction.

To highlight the components of stripping operation of the great saphenous vein and to offer a proposal for guidelines. 7789 admissions with venous insufficiency during the period, reaching seven and a half years were evaluated. Seventy- two admissions of nineteen patients were related to the recurrent symptoms due to previous incomplete stripping surgery. Doppler ultrasonography evaluations were made. The remained venous segment from the first operation was excised in the second operation. Mean duration between two operations was 7.44 years. Preoperative clinics were changing between C2s and C5 according to CEAP classification. Only nine patients could be persuaded to undergo the second operation. The remaining six patients rejected the second operation. While the patients who were operated on for the second time regained their health, others became the epitome of hopelessness and mistrust. They lost their confidence in medicine and surgery. If a stripping operation is planned, it should be performed in full accordance with the surgical procedure of stripping as mentioned in the classical textbooks. Guidelines should contain expressions reminding of ethical issues. This will prevent the dereliction of the duty and the loss of money, labor, time, health, patients' confidence in surgery (Tab. 1, Fig. 1, Ref. 18) Keywords: ethics, malpractice, quality of life, venous, saphenous, stripping.

Endovenous Laser Ablation Combined with Stripping Technique for Large Saphenous Varicose Veins: The Selection of Operation Technique.

Objective: Saphenous varicose veins can be accomplished by various operative techniques that result in stripping, ablation, or ligation of the venous reflux section. Great saphenous vein (GSV) stripping is one of the standard operations for varicose veins to eliminate reflux of the sapheno-femoral junction. The goal of any treatment regimen is to eliminate the junctional varicose reflux to control congestive dysfunction. Endovenous laser ablation (EVLA) is safe and effective with less postoperative pain, bleeding, and peripheral nerve damage than open surgery. In this study, a patient with severe progression of primary saphenous varicose veins is presented. We report the outcome of combined surgical strategy and perioperative treatment for extremely swollen varicose veins of the lower limbs to improve leg symptoms and congestion and/or promote skin ulcer healing.Materials and Methods: The subjects included 42 patients (51 limbs) who underwent EVLA with stripping. The patients comprised 24 males and 18 females, who presented a maximum GSV diameter >15 mm. The Clinical-Etiological-Anatomic-Pathophysiologic classification identified 9, 20, 9, 2, 6, and 5 limbs with C2, C3, C4a, C4b, C5, and C6, respectively, among the 42 patients.Results: EVLA was used to treat GSV with a mean length of 16.1±2.8 cm. The mean of the maximum GSV diameter was 16.8±3.2 mm (14.6–21.8 mm). The preoperative visual analog scale (VAS) score was 82.1±12.1. After operation, the VAS gradually deteriorated to 31.3±17.9 (p<0.0001), 2.8±3.6 (p<0.0001), and 1.2±1.8 (p<0.0001) in 7 days, 1 month, and 3 months, respectively.Conclusion: We obtained a satisfactory outcome from our combined strategy and perioperative treatment for extremely swollen saphenous varicose veins. This approach may show the possibility that lower saphenous varicose veins can induce cosmetic and minimally invasive ameliorated intervention to avoid late-phase incompetent perforating veins.

The Lesser Saphenous Vein: An Underestimated Source for Autolougus Vein Bypass

Introduction - Vein is regarded superior to artificial graft in peripheral arterial bypass surgery. However, often this option is limited due to previous bypass, stripping, or poor quality of the ipsilateral greater saphenous vein (GSV). In this case the contralateral GSV or arm veins are preferred alternative vein grafts. The lesser saphenous vein (LSV) is a forgotten, but attractive alternative. There are only limited reports on the use of LSV as a bypass conduit available. We report our experience using LSV as part of an all autologous vein bypass policy.

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

A randomised controlled trial of perivenous tumescent anaesthesia in addition to general anaesthesia for surgical ligation and stripping of the great saphenous vein.

Open surgical ligation and stripping of the great saphenous vein is a highly cost-effective treatment when compared with conservative management and foam sclerotherapy but has limitations including post-operative morbidity and pain. This study aims to identify if the addition of tumescent anaesthesia could improve patient outcomes following treatment. Patients with primary superficial venous incompetence undergoing open surgical ligation and stripping of the great saphenous vein were randomised to either General Anaesthesia (GA) alone (GA) procedure or the addition of tumescent (G + T). The primary outcome was bodily pain (within SF-36) at one week. Additional outcomes included post-procedural pain score (100 mm visual analogue scale), complications and quality of life. A total of 90 patients were randomised for inclusion. There was no significant difference in primary outcome; bodily pain at one week. Secondary outcome of 4-h post-procedural scores were significantly lower in the G + T group (32 (20-54) mm vs. (GA alone) 56 (24-70) mm (P = 0.016)). Complications were minor and equivalent. Both groups saw a significant increase (worsening) in Aberdeen Varicose Vein Questionnaire scores at week 1 with the G + T group faring worse at six weeks (10.0 (Interquartile Range [IQR] 5.6-17.9) vs. 4.3 (IQR 2.7-7.9) P = 0.004). The G + T group did not demonstrate a significant difference in the one-week bodily pain domain. The addition of tumescent anaesthesia does improve immediate post-operative pain but appears to negatively impact on six-week quality of life. EudraCT Number: 2011-005574-39.

The intravascular ultrasound morphometry of iliac veins in subjects without severe chronic venous insufficiency and its implications for treatment indications and stent size selection.

The purpose of this study is to report the intravascular ultrasound morphometry of iliac veins and its relation to demographic and anthropometric factors in subjects without chronic venous insufficiency. Thirty-three patients, without chronic venous insufficiency - qualified to great saphenous vein stripping due to unilateral, primary varicose veins - participated in the study. During the surgery, left and right external iliac veins, common iliac veins and inferior vena cava were interrogated with intravascular ultrasound. The morphometric analysis included measurement of a cross-sectional area at normal, non-stenosed vein segments (ref-CSA) and at the point of the most prominent narrowing (minimal lumen area (MLA)). Based on these measurements, a percentage of stenosis (S%) and calculated lumen diameter of interrogated veins were determined according to the following formulas, S% = (ref-CSA-MLA)/ref-CSA × 100 and CLD = 2 × √(ref-CSA/π), respectively. Median ref-CSA, S% and calculated lumen diameter were 265.3 mm2, 45.8% and 18.4 mm for inferior vena cava; 193.9 mm2, 62.4% and 15.7 mm for left common iliac veins; 166.9 mm2, 35.7% and 14.2 mm for right common iliac veins; 136.5 mm2, 48.0% and 12.8 mm for left external iliac veins and 140.9 mm2, 46.3% and 13.5 mm for right external iliac veins. There were statistically significant differences between left and right common iliac veins ref-CSA, common iliac veins S% and common iliac veins calculated lumen diameter (p = 0.03, p < 0 and p = 0.03, respectively). The S% of left external iliac veins was greater in women 52.2 versus 37.2% in men (p = 0.04). Neither age nor anthropometric factors had any influence on the calculated lumen diameter of the analysed veins. A negative correlation between the left common iliac veins S% and the age was observed (p = 0.03). In adult subjects, the calculated lumen diameter of the common iliac veins is greater on the left side and is not influenced by age and body size. Common iliac vein stenosis occurs more frequently on the left side, decreases with age and tends to be more frequent in women.

Clinical Results 5 Years after Great Saphenous Vein Stripping

現在大伏在静脈型の下肢静脈瘤の標準治療としては血管内焼灼術が主体となっている．その背景として，欧米では大伏在静脈ストリッピング時の深部静脈接合部高位結紮後にできる新生血管に起因する再発率の高さが強調されてきたが，日本では同様の中長期成績はほとんど示されていない．今回，血管内焼灼術が自分の選択肢になかった2011年9月～2014年3月に，自身が術者として同一手技で行った大伏在静脈ストリッピング症例連続305例413肢に5年後連絡を取り，うち連絡のついた生存例287例391肢で再発，再手術について調査した．臨床症状を有する再発は29肢（7%），うち再手術は調査後に行った15肢を含め23肢（6%）であった．270肢（69%）に静脈エコーを施行して再発部位を分析した結果，とくに深部静脈接合部付近の再発に限ると，臨床症状を有する再発は3肢（新生血管2肢，高位結紮遺残部側枝1肢）で，そのうち再手術は1肢と，欧米の諸報告よりかなり少なかった．

Modified memory sub-test of Syndrom Kurz test in middle-aged and elderly Chinese

Objective: To investigate the applicability of the modified memory sub-test of syndrom kurz test (SKT-M) in middle-aged and elderly Chinese. Methods: Between March 1, 2017, and October 31, 2017, at HwaMei Hospital, 132 patients receiving elective great saphenous vein high ligation and stripping operation and 96 their accompanying dependents, 55-75 years old, were randomly divided into the SKT-M group (n=121) and auditory verbal learning test -huashan version (AVLT-H) group (n=107) using random numeral method. The two groups underwent two corresponding neuropsychological tests respectively on the day before surgery and the second day after surgery. Results: There was no significant difference in the baseline characteristics and all the neuropsychological indices at the two time points between patients and dependents (P>0.05). As a consequence, the data of the patients and dependents were integrated to compare the applicability of SKT-M and AVLT-H. The "low-score" ratio of SKT-M immediate recall (2.4%) was lower than that of AVLT-H test (12.1%) (χ(2)=8.138, P<0.01). Besides, the "low-score" ratio of SKT-M delayed recall (5.7%) was also lower than that of AVLT-H test (20.5%) (χ(2)=11.167, P<0.01). The influence factors of SKT-M were less than that of AVLT-H test. However, the learning effect of SKT-M immediate recall was more significant, for its first testing sore (23.1±5.4) was significantly higher than the second one (21.9±5.1) (t=-3.971, P<0.001). Conclusion: The SKT-M has better applicability to 55-75 years old Chinese than AVLT-H test, but its learning effect should be noted.

Outcomes of knee-groin great saphenous vein stripping in patients with chronic venous insufficiency

Background: The clinical importance of the remaining part of the great saphenous vein (GSV) after knee-groin (Short) stripping is not clearly understood. The aim is to compare long (Ankle-groin) and short GSV stripping methods in terms of symptoms, quality of life, recurrence and complications.Methods: A total of 26 patients with chronic venous insufficiency were classified as long and short GSV stripping groups. Results: Preoperatively, the two groups were similar in terms of all scoring systems. Patients with short GSV stripping had better scores in general health category of SF-36 (At postoperative 1st month), in categories of general health and emotional well-being (At postoperative 3rd month), and in the parameters of night cramps and heaviness in the legs (At postoperative 6th month), compared to those with long GSV stripping.Conclusions: Short GSV stripping may be considered as the first step surgical option in such patients.

Different management options for primary varicose veins in females: A prospective study

BackgroundThe aim of this study was to evaluate the long-term follow-up results of different management modalities in treating primary uncomplicated lower limb female varicosities. MethodsA prospective study took place within a 3-year period from June 2010 until May 2012. Patients were divided into 3 groups: group I (n = 35) included those who underwent open surgical treatment. Group II (n = 25) included those who subjected to ultrasound-guided foam sclerotherapy (USGFS). While group III (n = 20) included those who treated with endovenous laser therapy (EVLT). The patients were followed up for 6 years. ResultsAll selected patients were female aged from 35-62 years with a mean of 47 ± 7.6 years. Thirty-five patients (43.75%) were treated surgically by saphenofemoral junction disconnection (SFJD), and great saphenous vein (GSV) stripping; 25 patients (31.25%) with ultrasound-guided foam sclerotherapy and the remaining 20 patients (25%) were treated with endovenous laser therapy. A significant success rate of GSV ablation was obtained for the endovenous laser therapy treated group over the ultrasound-guided foam sclerotherapy treated patients (P = .023). There was no significant difference between the surgically treated group and those group treated with endovenous laser therapy (P = .85). Recurrence was observed following long-term follow-up after 6 years in 8.5% in group I, 36% in group II, and 10% in group III, respectively. Venous clinical severity score (VCSS) and health-related quality of life score (HRQOLS) improved significantly in all treated groups. ConclusionsLong-term follow-up of patients with primary superficial varicosities among females is mandatory to elucidate the postoperative recurrence, especially those who underwent ultrasound-guided foam sclerotherapy. In addition to the observation of the development of newly formed varicosities in susceptible individuals which might develop later following long-term follow-up.

Determination of vascular endothelial growth factor concentration in serum of patients with varicose veins after conventional phlebectomy and hybrid treatment

Objective. To study the change of the vascular endothelial growth factor (VEGF) level and the incidence of recurrence of varicose veins after conventional phlebectomy and hybrid treatment.&#x0D; Materials and methods. Conventional phlebectomy was performed according to standard technique. Hybrid treatment consisted of combination of methods, including laser ablation, ultrasound guided foam form sclerotherapy (aethoxysklerol 1-3%), high degree of ligation (HL), total or partial stripping of saphenous vein. The treatment was personalized to every patient. This study included 134 patients, that were divided into two groups, depending on the method of treatment. Serum samples were collected from patients before operation and in 3-12 months after operation. Control group included 20 healthy persons. We analyzed mean concentration and change of the VEGF levels in patients’ serum before and after treatment.&#x0D; Results. Mean levels of VEGF decreased in 3.95 – 5.38 times after the treatment. Also, recurrent cases were estimated. In the case of the recurrence, VEGF levels were higher than in non-recurrent cases.&#x0D; Conclusions. Therefore, results of the study suggest an association between the recurrence of varicose veins and the change of VEGF level.

Steam ablation versus stripping of great saphenous varicose veins.

Use of new technology can lead to changes in the treatment course for patients and in treatment costs for the health service. The aim of this study was to compare sickness absence and time to resumption of daily activities, as well as treatment costs, for two surgical treatments for varicose veins: endovenous steam ablation and vein stripping. This prospective observational study included 46patients treated with steam ablation and 37 treated with vein stripping in the period 2015-2016. The two groups were matched with respect to age, sex, occupational status and classification. After treatment, patients were interviewed every other week until daily activities had been resumed. Detailed information on expenditure related to personnel, equipment, premises and materials was used to calculate the cost of treatment. Patients treated with steam ablation resumed daily activities after a median of 0 (interquartile range 0-2) days versus 4 (2-7) days for vein stripping (p < 0.001), and sporting activities after 4 (2-9) days versus 11 (3-19) days (p < 0.004). For patients in employment, sickness absence after steam ablation was 2 (2-5) days versus 14 (6-21) for patients treated with vein stripping (p < 0.001). The estimated treatment cost for steam ablation was NOK 5 973, compared with NOK 10 109 for vein stripping. Steam ablation led to shorter convalescence and sickness absence for the patient, and lower costs for the hospital. Reduced sickness absence also implies lower costs for society.