Saphenous Vein Stripping Research Articles

LEV 2. Preliminary First in Human Ultrasound-Guided High-Intensity Focused Ultrasound Treatment in Superficial Lower Limb Veins

High-intensity focused ultrasound (HIFU) is an alternative to surgery or other thermal methods widely used in the treatment of thyroid, breast fibroadenoma, and uterine fibroma. HIFU generated by the Echopulse (Theraclion, Malakoff, France) device penetrates through tissues and causes localized hyperthermia responsible for irreversible protein denaturation and vein wall coagulation, whereas overlying and surrounding tissues are spared by focusing a beam into a given target. A focused transducer (3 MHz frequency) generates the ultrasound field. An imaging array of 7.5 MHz is centrally integrated to allow perfect alignment between the real-time imaging and the focal point. A first in human prospective study is ongoing, and patients were observed up to 3 months. We have several examples of positive results that are currently available. Most of the cases were performed without anesthesia and were well tolerated, and no severe adverse events were observed. A female patient presenting with recurrence after great saphenous vein (GSV) stripping received 12 pulses with a mean power of 45 W. No anesthesia was performed. The treated area was occluded acutely, and this result persisted at 3 months. A female patient presenting with a refluxing stump and neovascularization after GSV stripping as well as an active ulcer was treated at the groin level, over the stump and area of the neovessels. Ten pulses were delivered with a mean power of 42.9 W. No anesthesia was performed. The recurrent flow was abolished, and the ulcer was healed at 3 months. A male patient presenting with a refluxing calf perforator was treated after unsuccessful surgery and sclerotherapy. Nine pulses were delivered at a mean power of 45 W. No anesthesia was performed. The perforator was occluded acutely, and this result persisted at 3 months. A male patient presenting with a refluxing GSV and active ulcer was treated after surgery. Thirty-nine pulses were delivered with a mean power of 38 W. Tumescent anesthesia was performed. The vein was occluded acutely, and this result persisted at 3 months. The ulcer was healed at 3 months. In this first study using HIFU, the preliminary results are encouraging and show that HIFU could become a credible alternative method. In future studies, more cases and longer follow-up will be needed.

Clinical, ultrasonographic and histological findings in varicose vein surgery

This study aims to correlate the demographic data, different clinical degrees of chronic venous insufficiency (CEAP), ultrasound findings of saphenofemoral junction (SFJ) reflux, and anatomopathological findings of the proximal segment of the great saphenous vein (GSV) extracted from patients with primary chronic venous insufficiency (CVI) submitted to stripping of the great saphenous vein for the treatment of lower limb varicose. This is a prospective study of 84 patients (110 limbs) who were submitted to the stripping of the great saphenous vein for the treatment of varicose veins of the lower limbs, who were evaluated for CEAP clinical classification, the presence of reflux at the SFJ with Doppler ultrasonography, and histopathological changes. We study the relationship between the histopathological findings of the proximal GSV withdrawal of patients with CVI with a normal GSV control group from cadavers. The mean age of the patients was higher in the advanced CEAPS categories when comparing C2 (46,1 years) with C4 (55,7 years) and C5-6(66 years), as well as C3 patients (50,6 years) with C5-6 patients. The normal GSV wall thickness (mean 839,7 micrometers) was significantly lower than in the saphenous varicose vein (mean 1609,7 micrometers). The correlational analysis of reflux in SFJ with clinical classification or histopathological finding did not show statistically significant findings. The greater the age, the greater the clinical severity of the patients. The GSV wall is thicker in patients with lower limb varicose veins, but those histopathological changes are not correlated with the disease's clinical severity or reflux in the SFJ on a Doppler ultrasound.

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.

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

Virtual Learning, a New Pillar of Teaching Learning Method

Introduction : Varicose Veins are Defined as “ Permanently Elongated, Dilated vein/veins with tortuous path causing pathological circulation”.Varicose veins can develop anywhere in the body but are most commonly seen in the lower limbs. A detailed knowledge of the mechanism of hemodynamic failure and the underlying anatomy is important in deciding treatment of the patient with chronic venous disease. Methodology : The aim of this study was to determine the correlation between different complications of varicose veins and Recurrence rate of Complications with the treatment undergone by the patient. Total 30 patients were randomly assigned to Conservative management (i.e. Limb End Elevation, Elastic Stockings Application & Intermittent Bed rest to avoid prolonged Standing) or Surgical management (i.e. Trendelenburg Operation with Great Saphenous Vein Stripping). Special focus was given to the follow-up visit of the patients who were asked to be present for review every week, till two months so as to be vigilant regarding the occurrence of complications.Results : Out of 30 patients, 15 were treated surgically while 15 were treated conservatively. Eleven (11) patients in total developed some complications in post treatment part. The commonest complication observed in post surgical patients was haematoma. Recurrence of Varicosity was seen in 4 patients who were previously managed conservatively. A single case of wound infection and ulcer formation were observed in each respectively. Out of the 11 patients who had developed some complications, 5 patients had undergone surgical management, while 6 patients had undergone conservative management.Conclusion : Surgical Intervention is better than conservative management in Varicose veins. The rate of complications / recurrence over a 2 months period was less in the surgical group than in the group managed by conservative therapy.

Role of Fentanyl in Attenuation of Haemodynamic Changes during Electroconvulsive Therapy

Introduction : Varicose Veins are Defined as “ Permanently Elongated, Dilated vein/veins with tortuous path causing pathological circulation”.Varicose veins can develop anywhere in the body but are most commonly seen in the lower limbs. A detailed knowledge of the mechanism of hemodynamic failure and the underlying anatomy is important in deciding treatment of the patient with chronic venous disease. Methodology : The aim of this study was to determine the correlation between different complications of varicose veins and Recurrence rate of Complications with the treatment undergone by the patient. Total 30 patients were randomly assigned to Conservative management (i.e. Limb End Elevation, Elastic Stockings Application & Intermittent Bed rest to avoid prolonged Standing) or Surgical management (i.e. Trendelenburg Operation with Great Saphenous Vein Stripping). Special focus was given to the follow-up visit of the patients who were asked to be present for review every week, till two months so as to be vigilant regarding the occurrence of complications.Results : Out of 30 patients, 15 were treated surgically while 15 were treated conservatively. Eleven (11) patients in total developed some complications in post treatment part. The commonest complication observed in post surgical patients was haematoma. Recurrence of Varicosity was seen in 4 patients who were previously managed conservatively. A single case of wound infection and ulcer formation were observed in each respectively. Out of the 11 patients who had developed some complications, 5 patients had undergone surgical management, while 6 patients had undergone conservative management.Conclusion : Surgical Intervention is better than conservative management in Varicose veins. The rate of complications / recurrence over a 2 months period was less in the surgical group than in the group managed by conservative therapy.

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.

Management of large chronic venous leg ulcers with negative pressure wound therapy

Introduction: Venous leg ulcers (VLU) occur in 1\% of the adult population and are associated with chronic disability, diminished quality of life and high health-care costs. Treatment is often slow, difficult and recurrence is high because of inappropriate conditions of the wound bed.
 Patients and Methods: This study involves 14 patients with chronic venous ulcers larger than 100 cm\textsuperscript{2} treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalized tissues and partial stripping of an insufficient great saphenous vein in the first operation. After adequate haemostasis, NPWT kit was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Dressing impregnated with neutral triglycerides and silver ions was used as a first layer and the black polyurethane NPWT foam was applied over it. The pain assessment was performed for 7 patients using 10 cm visual analog scale (VAS).
 Results: The mean number of NPWT dressing changes prior to grafting was 5.8. The mean number of NPWT foam changes was 2.8 after skin grafting. We accomplished complete healing of 92\% of applied skin grafts surface. One patient had recurrence of venous ulcers in the follow-up period. Moreover, one patient required regrafting.
 Conclusions: The application of NPWT provides quick wound-bed preparation and high graft take in venous ulcer treatment.

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.

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.

Causes and Treatment of Varicose Recurrence in the Popliteal Region

Background: In a previous study of 1,081 limbs affected with varicose recurrence (VR) at the saphenofemoral junction (SFJ) and at the sapheno-popliteal junction (SPJ), the anatomical causes were investigated. VR appeared to be due to inadequate diagnosis and surgery; neoangiogenesis appeared to play a minimal role. The so-called cavernoma was secondary to reflux and consisted with a complex collateral circulation (CC). Only 52 of 1,081 (4.8%) studied limbs developed a VR at the SPJ, but the anatomical findings were poorly described. The aims of this study were: 1) to distinguish between VR at the SPJ and the ones caused by different sources of reflux, 2) the reliability of the preoperative DUS examination, and 3) the efficacy and safety of the treatment. Methods: DUS examinations, surgery and sclerotherapy were performed by one single group of physicians. Nineteen of 207 (9.1%) limbs affected with VR at the popliteal region were studied and treated. Most of the previous interventions performed in different vascular units (only one in our center) were high or low interruption +/- stripping of the small saphenous vein (17/19, 89.4%). VRs > 3 mm were treated by surgical high ligation and intraoperative sclerotherapy in 13/19 (68.4%) and short invagination stripping in 1/19 (5.2%); 4/19 (21.0%) with VR 3 mm) at the PR. Sclerotherapy gave satisfactory results in the treatment of the smallest VR (< 3 mm). J Curr Surg. 2017;7(3):27-34 doi: https://doi.org/10.14740/jcs325w

Subfascial endoscopic perforator surgery in treating varicose ulcer after great saphenous vein stripping

Objective To evaluate the feasibility and efficacy of subfascial endoscopic perforator surgery in treating varicose ulcer after great saphenous vein stripping. Methods Between July 2008 and July 2013, 152 limbs of venous ulceration after great saphenous vein stripping were divided into two groups(conservative therapy and subfascial endoscopic perforator surgery therapy) and followed up at least for 2 years, respectively compared symptoms and signs improvement, ulcer healing time, ulcer healing and ulcer recurrence rate after healing for 6, 12, 24 months. Results No patient underwent the surgery occured pulmonary embolism or death, 2 limbs appeared hematoma. Conservative and subfascial endoscopic perforator surgery group′s symptoms and signs improvement rates were 81.9%(59/72) and 86.3%(69/80)(not significant, P=0.528), while the ulcer healing time, ulcer healing and ulcer recurrence rate respectively were 65.3%(47/72) and 78.8%(63/80), (73±15.7) d and (41±12.6) d, 34.0%(16/47) and 14.3%(9/63) (significantly different, P<0.05). According to the three time-points′ (6, 12, 24 months) follow-up, the non-recurrence rate were 89.4%(42/47) and 96.8%(61/63), P=0.135; 72.3%(34/47) and 92.1%(58/63), P=0.006; 66.0%(31/47) and 85.7%(54/63), P=0.014. Conclusions Subfascial endoscopic perforator surgery is a reliable, safe and minimally invasive surgery, and has a long-term effect in treating varicose ulcer after great saphenous vein stripping. Key words: Venous insufficiency; Surgical procedures, minimally invasive; Varicose ulcer

Radiofrecuencia en el tratamiento de las varices de los miembros inferiores. Estudio prospectivo en 176 pacientes en Bogotá

IntroductionChronic lower extremity venous insufficiency is fairly common, and varicose veins are main manifestation of this condition. The “classic” surgical treatment by stripping of saphenous veins leads to morbidity, disability, and recurrence rate. The use of endovascular methods is seen as an effective and safe alternative to conventional methods. ObjectiveTo determine the efficacy, safety, and advantages of radiofrequency for the treatment of lower limb varicose veins. Materials and methodsA prospective study was conducted on 176 patients (37 with venous ulcers) treated with radiofrequency and followed-up for 3 months. The variables studied were pain during and after the procedure, use of analgesics, post-operative complications, healing of ulcers, work incapacity, and the return to work activities. A visual analogue pain scale and Doppler ultrasound were used. ResultsNo complications were observed. The mean pain scale score during the procedure was 3, being 5 after the surgery. The patients returned to their work activities within a mean of 5 to 7 days, with little use of analgesics. The venous ulcer closed at 3 months in 95% of cases. There were no complications or recurrences, either clinically or with Doppler ultrasound, were observed in the follow-up. More than 30% of patients who had comorbidities and were rejected for conventional surgery were successfully intervened using radiofrequency. There was a statistical correlation in that, the younger the patient the lower the pain score during the procedure (P=.04). Those patients who referred to low or no pain returned to their work activities in the first week (P=.04). ConclusionRadiofrequency for the treatment of varicose veins is an effective and safe method. It leads to an early return to work activities by the patients.

Stump evolution after great saphenous vein stripping with high ligation

The aim of the present observational study is to show the evolution of great saphenous vein (GSV) stump in two different periods of follow up. From 2001 to 2009, 500 legs with GSV insufficiency and terminal valve reflux, operated on with stripping by invagination without crossectomy, were followed. Doppler were performed at 1 month (early) and then mid-term (2-year follow-up). The hemodynamic examination of residual stumps showed 4 different types: S1) draining and competent terminal valve; S2) thrombosis and fibrosis; S3) turbulence under Valsalva maneuver and normal antegrade flow at rest; S4) turbulence with reflux at rest: refluxing terminal valve. &lt;em&gt;Early&lt;/em&gt;: the most common finding was S1 (64%), then S2 (18%), S3 (12%) and S4 (6%); S1-S3 patterns were considered as &lt;em&gt;good&lt;/em&gt; evolution (94%), whereas S4 were considered recurrence. &lt;em&gt;Mid-term phase&lt;/em&gt;: the most common finding was again S1 (67%), then S3 (15%), S4 (10%) and S2 (8%). S1 evolution: out of 319 legs in S1 group at early phase, 294 (92%) remained still in S1 at mid-term follow up; 25 (8%) worsen to S3. S2 evolution: out of 92 legs in S2 at early phase, 42 (46%) improved to S1, 40 (43%) did not change pattern across time and 10 legs (11%) worsen to S4. S3 evolution: almost the legs in S3 (51, 86%) remained unchanged at mid-term, whereas 8 (14%) worsen to S4. S4 evolution: all the patients in S4 class at early follow up were still in the same class at mid-term. The evolution of GSV stump can be classified in 4 different patterns, where only S4 should be considered failure.

Pelvic congestion syndrome and left renal compression syndrome - clinical features and therapeutic approaches.

Knowledge of the anatomy of the pelvic, gonadal and renal veins is important to understand pelvic congestion syndrome (PCS) and left renal vein compression syndrome (LRCS), which is also known as the nutcracker syndrome. LRCS is related to PCS and to the presence of vulvar, vaginal and pudendal varicose veins. The diagnosis of the two syndromes is difficult, and usually achieved with CT- or phlebography. The gold standard is the intravenous pressure measurement using conventional phlebography. The definition of PCS is described as pelvic pain, aggravated in the standing position and lasting for more than 6 months. Pain in the left flank and microhaematuria is seen in patients with LRCS. Women with multiple pregnancies are at increased risk of developing varicose vein recurrences with pelvic drainage and ovarian vein reflux after crossectomy and stripping of the great saphenous vein. The therapeutic options are: conservative treatment (medroxyprogesteron) or interventional (coiling of the ovarian vein) or operative treatment (clipping of the ovarian vein). Controlled prospective trials are needed to find the best treatment.

Barrier Patch Implantation during Redo Surgery for Varicose Vein Recurrences in the Groin: 1-Year Results

Rerecurrences after redo surgery for recurrent varicose veins in the groin are a common problem. The present report looks at the efficacy of an additional barrier patch implantation in reducing these rerecurrences. A retrospective review of a prospectively collected database was conducted. This included 67 patients with 86 legs who underwent redo-groin surgery for symptomatic recurrences. In addition, a polytetrafluoroethylene-barrier patch was placed at the former saphenofemoral junction. All patients had undergone ligation and stripping of the great saphenous vein a mean of 13.9years earlier. All patients were examined by duplex ultrasound before and 1 year after the procedure. Perioperatively, minor complications occurred in 5.8% of cases, the groin infection rate was 2.4%. In 85 of 86 legs, the duplex follow-up examination was performed after 1 year. This revealed an overall rerecurrence rate of 12%, of which only 2.4% were caused by recurrent neovascularization in the groin bypassing the barrier patch. The remaining 9.6% were caused by different sites of reflux (pelvic veins and perforators). Redo-groin surgery with additional barrier patch implantation seems to be a safe and effective way to prevent rerecurrences in the groin. In our experience, it provided very promising 1-year results with a very low rate of recurrent neovascularization.

A multicenter review of epidemiology and management of varicose veins for national guidance.

BackgroundVaricose vein is a common surgical problems in India. This study was done to assess the clinico-epidemiological profile, risk factors and management practices in varicose veins.Materials and methodsMedical records of 170 varicose vein cases admitted in tertiary care hospitals in Mangalore between May 2011 to April 2014 were reviewed retrospectively.ResultsMajority of cases 53(31.2%) were of the age group 41–50 years. Majority were males 127(74.7%) and majority were unskilled workers 101(59.4%). Superficial veins were involved in 123(72.4%) cases. Perforator followed by great saphenous vein were most frequently involved. Veins on the left side were more involved than on the right. Common symptoms at the time of presentation was ulceration 98(57.6%) followed by pain in the legs 96(56.5%). Ulceration was seen significantly more among females (p = 0.027) and among house wives (p = 0.004). Complications like eczema 46(27.1%), non-healing ulcers 21(12.3%) and deep vein thrombosis 10(5.9%) were reported among cases. Eczema was present significantly more among elderly patients aged above 60 years (p = 0.019). Risk factors like prolonged standing was observed in 86(50.6%) cases. This history was significantly seen among males (p = 0.001) and among those involved in unskilled occupations (p < 0.001). Recurrence of varicose vein was reported in 23(13.5%) cases. It was associated with patients of the age group 21–30 years (p = 0.021). Doppler ultrasound was the most common 120(70.6%) investigation done. Micronized purified flavonoid fraction was used in management in 15(8.8%) cases. Conservative management methods like limb elevation 50(29.4%) and compression stocking 36(21.2%) was advised to patients. Saphenous vein stripping was the most common surgical procedure 40(23.5%) performed.ConclusionThe high risk groups identified in this study need to be made aware of risk of developing varicose veins. Use of compression stocking at work place added with newer procedure in management could help in betterment in their quality of life.

Frequency of refluxive tributaries of the junction region in the groin in patients with recurrent varicose veins of the thigh

SummaryBackground A long stump and neovascularisation are commonly discussed reasons for recurrence of varicosis in the groin after “disconnection” of the saphenofemoral junction (SFJ) and stripping of the great saphenous vein (GSV). A third possible reason for recurrence with non femoral reflux emerging from tributaries of the junction region, is often underrated. The aim of the study was to report on the source of reflux for recurrent varicose veins of the thigh in patients who already had a history of disconnection of the SFJ and stripping of the GSV.Methods In this two-centre study, consecutive patients with a history of disconnection of the SFJ, stripping of the GSV and visible or palpable varicose veins of the thigh region were included. Their data and venous diagnostics (DPPG, duplex scan) were recorded and evaluated by a standardised protocol.Results 101 legs were included. In 58.4 % there was a long stump of the GSV as a source for variose veins of the thigh. In the other legs (42,6 %) the source for the reflux was not a long stump with contact to the femoral vein but residual tributaries of the SFJ, e.g. the superficial epigastric vein or the superficial circumflex iliac vein.Conclusions Residual refluxive tributaries of the SFJ seem to be an important source for recurrent varicose veins of the thigh. Further prospective studies should focus on suitable therapeutic options.

Comparison of cutaneous nerve injury and vessel disruption complications following saphenous vein stripping using big or small olive heads.

Objective:To compare the nerve injury and vessel disruption complicaitons in patients undergoing saphenous vein stripping using olive heads of different sizes.Methods:Big olive heads were used in group A (n=50) and small olive heads were used in group B (n=50) from the ankle to the groin; in group C (n=50), the vein was stripped in two sections; in an upward fashion by stripping the distal portion from the ankle to the level of the knee using small olive heads and by stripping the proximal portion from the knee to the level of the groin using big olive heads.Results:Six months after the operation, nerve injury symptoms were identified in 26%, 4%, 6% of patients in groups A, B, and C respectively. Vessel disruption occurred 2% in group A, 32% in group B, and 4% in group C. Both vessel disruption and nerve injury complications of group C were significantly lower than group A and B (p<0.001).Conclusion:Saphenous stripping using big olive heads for the proximal portion from the groin down to the level of the knee and using small olive heads for the distal portion from the knee to the level of the ankle is the alternative method which results in minimal nerve injury and vessel disruption.

Comparison of ligation versus ligation with stripping of long Saphenous vein in varicose veins of lower limb

Comparison of ligation versus ligation with stripping of long Saphenous vein in varicose veins of lower limb