Short Saphenous Vein Surgery Research Articles

Duplex scanning is no substitute for surgical expertise in identifying the saphenopopliteal junction: results following short saphenous vein surgery

Short saphenous vein (SSV) surgery carries a high risk of failure to identify the saphenopopliteal junction (SPJ). We assessed the impact of surgical expertise on anatomical outcome from SSV surgery and the role of preoperative duplex SPJ marking in improving outcome for vascular and non-vascular specialists. A retrospective analysis identified patients (30 limbs) who had undergone SSV surgery. These were recalled for duplex scanning of the SPJ. In a prospective study, 187 limbs had preoperative duplex marking of SPJ and postoperative duplex to assess outcome. Grade of operating surgeon was recorded in both retrospective and prospective analysis. In both retrospective and prospective analysis, vascular specialists were significantly more likely than non-vascular specialists to correctly identify the SPJ (P < 0.0001). Preoperative SPJ marking did not improve outcome for the vascular specialist or the non-vascular specialist. Preoperative SPJ marking is no substitute for surgical expertise. Competence in SSV surgery should be assessed prior to surgeons proceeding to independent practice.

Compartment syndrome following short saphenous varicose vein surgery: a case report

Compartment syndrome is an infrequent but serious complication which can occur post-operatively. In our case, a patient developed severe left calf pain following short saphenous vein surgery. She underwent emergency fasciotomy and made an excellent recovery. Informed consent for varicose vein surgery should probably include the possibility of developing compartment syndrome.

Common peroneal nerve injury as a complication of short saphenous vein surgery

To determine the incidence of common peroneal nerve (CPN) injury following short saphenous vein surgery (SSV) in a UK district general hospital, and establish possible risk factors, and preventative strategies to minimize the risk of nerve injury following this type of surgery. Retrospective review of all cases of SSV surgery performed in a single institution during the period January 2002-October 2004. Sixty-four patients underwent SSV surgery during the review period. Three patients (4.7%) developed a CPN injury postoperatively. One patient recovered fully after 24 h, whereas the other two patients' symptoms recovered within six months. All three patients had a saphenopopliteal junction (SPJ) located high above the popliteal skin crease. CPN injury during SSV surgery occurs with an appreciable frequency. In view of this, there is a need for a revised approach to the management of SSV disease, possibly incorporating less-invasive techniques such as endovenous closure.

The morphology of the varicose short saphenous system

Objective: Surgery for the varicose short saphenous vein (SSV) remains unsatisfactory. Specific problems include locating the saphenopopliteal junction (SPJ) and whether the trunk should be stripped. Recurrence rates are high. The objective was to review the morphology of varicose SSV and to address these aspects. Methods: Retrospective study of consecutive patients scheduled for SSV surgery based on initial continuous wave Doppler assessment. Detailed analysis of preoperative duplex ultrasound examinations with quantified reflux. Results: A total of 56 limbs (unilateral) were studied, male to female ratio was 18:38 and mean age was 51 years. SPJ: severe reflux in 47, mean diameter 8.1 mm (all above the skin crease [mean 2.7 cm]). Reflux was 'focal', being confined to the peri-junctional area with normal sized and competent distal short saphenous trunks in 29. In the remainder, incompetence was 'complete' with dilatation and reflux of the entire system. In only one limb did varicosities arise distally from a proximally competent system. Long saphenous vein ( LSV): coexistent reflux in 17, with communications with the SSV in 11. Deep reflux: at least one segment of deep reflux was found in 24 limbs. In this small study, no significant association with other morphology was found apart from 'complete' SSV reflux. Conclusion: The SPJ is usually severely incompetent, enlarged and sited above the skin crease. The morphology of the varicose SSV exhibits important differences from the LSV. In over half, incompetence is 'focal', confined to the peri-junctional vein and the distal trunk is competent suggesting a case for selective trunk stripping. Varicosities arising from a distally incompetent short saphenous trunk are uncommon.

Incomplete saphenopopliteal ligation after short saphenous vein surgery: a summation analysis

Incomplete saphenopopliteal ligation after short saphenous vein surgery: a summation analysis

The Management of Short Saphenous Varicose Veins: A Survey of the Members of the Vascular Surgical Society of Great Britain and Ireland

Objective. The outcome of short saphenous vein surgery is often unsatisfactory and the high litigation rate reflects this. The aim of this study was to explore the current management of short saphenous varicose veins in Great Britain and Ireland. Methods. This was a postal questionnaire survey of the surgical members of the Vascular Surgical Society of Great Britain and Ireland. Of 532 questionnaires 379 were returned (71.2%). Results. There was diversity of opinion about the management of short saphenous veins. Eighty nine per cent of surgeons requested duplex imaging for all patients and over 50% arranged additional duplex marking of the saphenopopliteal junction preoperatively. Only 10.4% formally exposed and identified the popliteal vein during saphenopopliteal ligation, the majority (75.7%) dissected down the short saphenous vein to visualise the junction. The short saphenous vein was stripped routinely by 14.5% of surgeons, the majority preferring to excise a proximal segment of up to 10 cm (55.1%). Compared with long saphenous vein surgery, surgeons were generally more likely to warn patients of nerve damage but equally likely to warn of deep vein thrombosis. A small number of surgeons failed to warn patients of these complications. Conclusion. The variation in management of short saphenous veins may be explained by the lack of definitive clinical trials in this area.

Colour flow duplex scanning in short saphenous vein surgery and echosclerotherapy

Colour flow duplex scanning in short saphenous vein surgery and echosclerotherapy

Recurrent Varicose Veins after Short Saphenous Vein Surgery: A Duplex Ultrasound Study

Recurrent venous reflux in the popliteal fossa of patients with recurrent varicose veins following short saphenous vein surgery was assessed in 70 limbs using a duplex scanner. Incompetence of the short saphenous vein was found to be the main source (61%) of venous reflux in the popliteal fossa (43/70). The recurrence or persistence of the short saphenous vein was subdivided into four types: an intact saphenopopliteal junction, as well as an intact short saphenous vein in 20 limbs (type I); varicosities in the popliteal fossa communicating with a short saphenous vein stump in 11 limbs (type II); a residual short saphenous vein communicating with the popliteal vein via a tortuous recurrent vein in eight limbs (type III); and a segment of residual short saphenous vein with no communication with the popliteal vein in four limbs (type IV). Incompetence of a gastrocnemius vein was involved in 24 cases (34%), an incompetent popliteal area vein in one (1.4%), popliteal vein incompetence in 15 (21%), and popliteal fossa varicosities communicating with the long saphenous system in two (3%). Of 12 limbs tested pre- and postoperatively, a high termination of the short saphenous vein was demonstrated in four of seven residual incompetent short saphenous veins. Duplex scanning is recommended to assess recurrent venous reflux in the popliteal fossa. It can be used to determine the level of an incompetent saphenopopliteal junction and the level of the termination of any other incompetent vein in the management of varicose veins recurring after a short saphenous vein operation. Copyright © 1996 Published by Elsevier Science Ltd.

Recurrent varicose veins after short saphenous vein surgery: a duplex ultrasound study

Recurrent venous reflux in the popliteal fossa of patients with recurrent varicose veins following short saphenous vein surgery was assessed in 70 limbs using a duplex scanner. Incompetence of the short saphenous vein was found to be the main source (61%) of venous reflux in the popliteal fossa ( 43 70 ). The recurrence or persistence of the short saphenous vein was subdivided into four types: an intact saphenopopliteal junction, as well as an intact short saphenous vein in 20 limbs (type I); varicosities in the popliteal fossa communicating with a short saphenous vein stump in 11 limbs (type II); a residual short saphenous vein communicating with the popliteal vein via a tortuous recurrent vein in eight limbs (type III); and a segment of residual short saphenous vein with no communication with the popliteal vein in four limbs (type IV). Incompetence of a gastrocnemius vein was involved in 24 cases (34%), an incompetent popliteal area vein in one (1.4%), popliteal vein incompetence in 15 (21%), and popliteal fossa varicosities communicating with the long saphenous system in two (3%). Of 12 limbs tested pre- and postoperatively, a high termination of the short saphenous vein was demonstrated in four of seven residual incompetent short saphenous veins. Duplex scanning is recommended to assess recurrent venous reflux in the popliteal fossa. It can be used to determine the level of an incompetent saphenopopliteal junction and the level of the termination of any other incompetent vein in the management of varicose veins recurring after a short saphenous vein operation.

Short Saphenous Vein Surgery, Pre-Operative Doppler Ultrasound Marking Compared with on-Table Venography and Operative Findings

Unidirectional Doppler ultrasound is a simple and inexpensive adjunct to the clinical examination of varicose veins; its accuracy in determining the level of the saphenopopliteal junction has not previously been assessed. A total of 30 limbs with saphenopopliteal reflux were examined with a portable Doppler on the day of surgery and the upper limit of reflux marked. This was compared with the findings of on-table venography and surgery. Venography provided accurate anatomical information in only 84% of cases, in the failures the Doppler mark proved useful by eliminating the need for multiple incisions. Doppler estimation of the saphenopopliteal junction was correct in only 40% of cases but in nine cases out of 10 it was within 2 cm; a distance that will allow appropriate surgery through a single incision. In experienced hands the use of unidirectional doppler may eliminate the need for pre-operative venography in selected cases.