Stripping Of Great Saphenous Vein Research Articles

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

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.

Prospective Randomized Study of Ultrasound-Guided Foam Sclerotherapy Combined with Great Saphenous Vein High Ligation in the Treatment of Severe Lower Extremity Varicosis

To evaluate the effect of ultrasound-guided foam sclerotherapy (UGFS) in a single session combined with great saphenous vein (GSV) high ligation for severe lower extremity varicosis classified as C4-C6, compared with GSV stripping plus multistab avulsion or transilluminated powered phlebectomy (TIPP). From January 2012 to December 2014, 177 patients with primary GSV insufficiency, classified as C4-C6, were randomized into the UGFS group or the control group. The UGFS group was managed by GSV high ligation and foam sclerotherapy in one session under the surveillance of ultrasonography, whereas the control group received GSV high ligation and stripping combined with multistab avulsion or TIPP. The patients were followed up at 1, 6, and 12months after treatment. Outcome assessments included reflux recurrence rate, procedure-related adverse events, hemodynamic parameters, revised Venous Clinical Severity Score (VCSS), and Aberdeen Varicose Vein Questionnaire (AVVQ) score. The medical cost and operating time of the 2 groups were also compared. In total, 73 patients received UGFS, whereas 90 patients underwent traditional surgery. Sixty-five patients in the UGFS group (89.0%) and 74 patients in the control group (82.2%) completed the follow-up. At the end of 12months, the cumulative refluxrecurrencerate was 13.8% in the UGFS group and 13.5% in the control group (P=0.955). In the UGFS and control groups, minor complications (27.7% vs. 21.6%, P=0.406) and major complications (3.1% vs. 2.7%, P=0.895) were not significantly different. Compared with baseline values, obvious improvements of the venous filling index, VCSS, and AVVQ scores after treatment were confirmed in both groups (P<0.001). The average operating and recovery times were much shorter (38.3 vs. 81.2min, 5.4 vs. 9.6days, P<0.001, respectively), and the average hospital cost was much lower ($853 vs. $1,575, P<0.001) in the UGFS group than in the control group. The patient satisfaction rate reached 92.3% in the UGFS group and 89.2% in the control group 12months after operation (P=0.270). Our outcomes indicated that UGFS combined with GSV high ligation was safe and effective for severe lower extremity varicosis.

Anatomical bases of external pudendal artery injuries during surgical treatment of pelvic limb varices

IntroductionL’artère pudendale externe est une branche collatérale de l’artère fémorale commune qui est destinée à la vascularisation du pénis ou du clitoris. Ses rapports avec la crosse de la grande veine saphène et de ses afférences, dans le trigone fémoral, sont très étroits. Cette situation fait qu’elle est souvent lésée lors de la crossectomie et de l’éveinage de la grande veine saphène. Ces lésions peuvent être à l’origine d’une dysfonction sexuelle.MéthodesIl s’agit d’une dissection de 22 régions inguinales chez 13 hommes et 9 femmes qui ont bénéficié d’un abord chirurgical du trigone fémoral. La distribution et les rapports de l’artère pudendale externe par rapport à la crosse de la grande veine saphène sont étudiés.RésultatsL’artère pudendale externe unique est la plus fréquente. Toutes les artères pudendales externes ont pour origine l’artère fémorale commune. Le rapport le plus fréquent est le sous croisement de la crosse de la grande veine saphène par une artère pudendale externe unique. Par ailleurs, on a un précroisement, un croisement alterné et des rapports avec la veine fémorale commune et des afférences de la crosse de la grande veine saphène. Certaines techniques chirurgicales exposent plus ou moins à une lésion de l’artère pudendale externe.ConclusionCe travail confirme les données antérieures mais montre encore quelques particularités sur les rapports entre la crosse de la grande veine saphène et l’artère pudendale externe.

Monitored anesthesia care for great saphenous vein stripping surgery with target controlled infusion of propofol and remifentanil: a prospective study.

BackgroundThe aim of this study was to determine the appropriate target concentrations at the effect site of propofol and remifentanil when deep sedation was achieved by monitored anesthesia care (MAC) anesthesia and related respiratory depression during vein stripping surgery for varicose veins.MethodsIn total, 51 adult patients who were scheduled for varicose vein stripping surgery were sedated with propofol and remifentanil during the surgery, after administration of midazolam. Target concentrations at the effect site of the two drugs were changed based on the patient's status. Respiratory support was applied in the order of oxygen supply, chin lift, and assisted mask ventilation. Target concentrations at the effect site of propofol and remifentanil, the need for respiratory support, and a six-point rating scale satisfaction score were the outcome measurements.ResultsOnly one patient did not require oxygen, eight patients needed oxygen alone, 22 patients required use of the chin lift technique, and 20 patients were assisted with mask ventilation. There was no significant difference in the target concentration of propofol or remifentanil between the patients who required mask ventilation and those who did not. Fifty of the 51 patients reported a satisfaction score of 6.ConclusionsAlthough MAC using low target concentrations of propofol and remifentanil during vein stripping surgery was satisfactory to patients, close observation regarding the need for respiratory assistance was necessary.

Postoperative prophylaxis of venous thromboembolism (VTE) in patients undergoing high ligation and stripping of the great saphenous vein (GSV).

To analyze the necessity of venous thromboembolism (VTE) prophylaxis for patients undergoing high ligation and stripping of the great saphenous vein (GSV) and to estimate the efficacy and safety of different anticoagulant protocols in a single-center randomized controlled trial with large sample size. A total of 2196 patients undergoing high ligation and stripping of the GSV were randomized to one of the following postoperative VTE prophylaxis protocols: group A, no VTE prophylaxis (n=542); group B, subcutaneous low-dose unfractionated heparin (LDUH) hypodermic injection, 125 U/kg per day in three divided doses (n=531); group C, low-molecular-weight heparin (LMWH) 6000 IU once a day (n=573); and group D, LMWH 4000 IU twice daily (n=550). Groups were compared for the incidence of VTE and major hemorrhage within 1 month following surgery. Varicose vein severity was classified by CEAP (Clinical, Etiologic, Anatomic, Pathophysiologic elements) score. The clinical characteristics of the patients were equally matched between groups. Postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE) were significantly higher in group A (DVT 5.17%, PE 1.48%) compared to groups B (0.56%, 0%), C (0.35%, 0%) and D (0.36%, 0%) (p<0.01). The incidence of VTE did not differ between the three active chemoprophylaxis arms. Hemorrhagic complications were low for each group but higher in group B (0.75%) compared to the other groups (group A 0.18%; group C 0.17%; group D 0.18%, p<0.01). Hemorrhagic complications did not differ amongst groups A, C and D. In conclusion, postoperative VTE chemoprophylaxis following high ligation and GSV stripping effectively reduces the venous thrombosis complications of this procedure. Of the three active strategies tested, no difference in efficacy was noted; however, thrice daily LDUH did increase bleeding complications.

Risk Factors and Saphenofemoral Junction in Varicose Veins

Introduction: Varicose veins (VVs) are dilated, tortuous, subcutaneous veins. It is common condition causing substantial morbidity. Prevalence of VVs ranges between 5% and 30% in the adult population. Surgery is one of the common modality of its treatment. A complete knowledge about anatomical variation at saphenofemoral junction (SFJ) and variations in tributaries of great saphenous vein (GSV) is important while dealing with such patients effectively. It will help in reducing chances of recurrences and complications. Methods: A prospective non-randomized study of fifty patients was carried out in our hospital between May 2014 and May 2015. Diagnosis was established by clinical examination and supplemented with venous duplex ultrasound study. Patients were subjected to trendelenburg's operation, stripping of GSV with hook phlebectomy of affected perforators. Results: A total of fifty patients were studied in this study, in which tobacco chewing was the most common associated risk factor with primary VVs, and it was observed in 46% of patients. Amongst them, twenty patients were obese with body mass index of more than 25 kg/m2 . Location of SFJ was a mean of 2.24 ± 0.55 cm inferior and 3.77 ± 0.61 cm lateral to the pubic tubercle on duplex ultrasound and 2.35 ± 0.42 cm inferior and 3.73 ± 0.58 cm lateral intraoperatively, both of which had nonsignificant P value. The number of tributaries varied from 2 to 6 at the first 5 cm from SFJ. There were two and six tributaries in one patient each whereas three tributaries were observed in 42% patients. The most frequent consistent branch was a superficial inferior epigastric vein, seen in 98% of patients. The least frequent branch was posterior accessory saphenous vein, seen only in 2% of patients. The external pudendal artery was crossing SFJ anteriorly in 38% and posteriorly in 56%, and it was not identified in remaining 4% patients. Conclusion: Our study showed the nonsignificant difference in Duplex ultrasound and intraoperative finding of SFJ location with respect to pubic tubercle; hence, one can plan a precise incision with the help of duplex ultrasound marking preoperatively. One must look for all tributaries for ligation which will prevent recurrence of varicose vein as variation in numbers and location of tributaries was remarkable in our study.

Randomizied clinical comparison of short term outcomes following endogenous laser ablation and stripping in patients with saphenous vein insufficiency

Objectives: The aim was to compare the effects of endovenous laser ablation (EVLA) and saphenous vein stripping on the quality of life of the patients and their short-term clinical outcomes in the treatment of isolated, symptomatic, unilateral greater saphenous vein (GSV) insufficiency. Materials and Methods: A total of 65 patients undergoing GSV stripping (n = 35) or EVLA (n = 30) for GSV (patients demonstrating backflow lasting more than 5 s during Valsalva maneuvers and those with a saphenous vein diameter more than 5 mm) between May 2013 and September 2013 were prospectively included in the study. Groups were compared for differences in clinical, etiological, anatomical and pathophysiological characteristics classification, venous clinical severity scores, and Short Form-36 (SF-36) quality of life scale. Results: Pre-operative and post-operative SF-36 scale scores in both groups were compared statistically and quality of life scores were found to be better in EVLA group with lesser number of complaints (P < 0.01). Despite the initial increase in the 1st week, the venous clinical severity score significantly declined in both groups after treatment, and it was significantly lower in the EVLA group at 1st month. Discussion: In GSV insufficiencies, EVLA is an efficient and safe treatment modality with better quality of life outcomes when compared with the stripping method. It offers better short-term relief of symptoms than stripping.

Outcome of Endovascular Treatment in Postthrombotic Syndrome

The postthrombotic syndrome (PTS) is a chronic complication of deep venous thrombosis (DVT) that is characterized by leg swelling and ulceration. Sixty-seven cases of PTS underwent attempted endovascular treatment with success in 63 between June 2005 and June 2012. Thirty-six cases underwent endovascular treatment only and 18 cases combined with temporary femoral arteriovenous fistula, 5 cases great saphenous vein ligation and stripping whereas 4 cases with communicating branch ligation around ulcers. Stenting was successfully performed in 63 of 67 patients. The technical success rate was 94% with no mortality. Fifty-eight cases were followed up from 1 to 84 months. Stent occlusion or restenosis occurred in 17 patients. The primary and secondary patency rates were 87.9% and 93.1%, respectively, at 12 months and 70.7% and 82.8%, respectively, at 36 months. Endovascular treatment of PTS is safe and effective. It can alleviate symptoms and prevent further deterioration of patients with PTS.

Long-term results of external valvuloplasty in adult patients with isolated great saphenous vein insufficiency.

ObjectiveThe aim of this study is to present our 7-year results of external valvuloplasty for isolated great saphenous vein (GSV) insufficiency.MethodsExternal valvuloplasty was applied in 83 patients with isolated GSV insufficiency. Follow-up consisted of venous color duplex scanning performed on the first postoperative day, the first postoperative month, and then annually. Valvular insufficiency, venous reflux, and venous thrombosis formation in the saphenofemoral junction were the main outcomes.ResultsA complete clinical and radiological healing was observed in 50 patients (60%). In 13 cases (15.6%), a secondary surgical treatment was performed consisting of vena saphena magna high ligation/stripping and varicose vein excisions, mainly due to severe and progressive vena saphena magna valvular insufficiency and clinical persistence of symptoms. Eight patients (9.6%) developed superficial vein thrombosis, and only one patient (1.2%) developed deep vein thrombosis. Contact was lost from 32 patients (38.5%) for different reasons.ConclusionExternal valvuloplasty is an effective surgical technique for selected cases of isolated GSV insufficiency without extensive varicose dilatations. This alternative method can be safely administered as an alternative to high ligation and conventional GSV stripping.

Crossectomy and Foam Sclerotherapy of the Great Saphenous Vein versus Stripping of Great Saphenous Vein and Varicectomy in the Treatment of the Legs Ulcers

Objective. To show our results in the surgical treatment of legs varicose ulcers, with crossectomy and foam sclerotherapy (CAFE) of the great saphenous vein (GSV) in group I and stripping of GSV and varicectomy in group II. Methods. 35 patients with active venous leg ulcers were recruited and treated. They were collected in two groups. Group I were treated by crossectomy and foam sclerotherapy of the GSV and group II were treated by stripping of GSV and varicectomy. The healing time of the ulcer and the complications were recorded after the procedure in the follow-up visits. Results. 29 out of the 35 patients completed the follow-up. There were eight cases of incomplete healing of the leg ulcer, 4 in group I (19.04%) and 4 in group II (40%), P&lt;0.05. The average rate of healing in group I was 0.38 cm/day and 0.13 in group II, P&lt;0.05. Conclusion. CAFE technique of the great saphenous vein in the treatment of 6 CEAP patients is a procedure that improves the rate of ulcer healing as compared to these two groups. It is a safe and reliable minimally invasive method, with less morbidity.

The Optimal Duration of Compression Therapy Following Varicose Vein Surgery: A Meta-analysis of Randomized Controlled Trials

The optimal duration of compression therapy following varicose vein surgery of the great saphenous vein (GSV) remains controversial. Therefore, the aim of this study was to evaluate different durations of compression therapy after varicose vein surgery and their outcomes. A systematic review and meta-analysis of randomized controlled trials (RCTs). Outcomes from short-duration (3–10 d) and long-duration (3–6 wk) compression therapy after GSV stripping and phlebectomies were evaluated. Pain was assessed post surgery using a visual analog scale. Secondary outcomes included leg volume, complications, and the duration of absenteeism from work. We identified 4 RCTs published between 1991 and 2009 that evaluated 686 patients. We observed non-significant differences in postoperative pain scores between the long-duration and short-duration groups, with a weighted mean difference of −0.03 (95% confidence interval (CI): −0.53 to 0.47) at 4 weeks, and −0.01 (95% CI: −0.31 to 0.33) at 6 weeks, postoperatively. We also observed non-significant differences in the incidence of postoperative complications (risk ratio: 0.84, 95% CI: 0.60–1.18), and changes in leg volume, 4 weeks postoperatively (P = .18) between the groups. Our study results indicate that there are no benefits to long-term compression therapy after varicose vein surgery of the GSV regarding postoperative pain, leg volume, incidence of complications, and duration of absenteeism from work.

Implications of the Expanded Venous Reflux Study

Background —Duplex ultrasonography remains the diagnostic modality of choice used to assess for venous reflux. Historically, our institution's practice assessed for deep venous reflux at the level of the common femoral and femoral veins, and the saphenous vein was only imaged at the saphenofemoral junction (SFJ). The American Venous Forum's Varicose Vein Venous Registry attempts to standardize the collection and analysis of clinical information on venous disease. As such, patients are subjected to a more complete study that expands on the superficial venous system. This investigation aims to identify those patients with superficial venous reflux whose diagnosis may have been missed with our previous protocol. Methods —This study reflects a retrospective review of all venous reflux studies performed with the expanded imaging protocol between October 1, 2010 and July 29, 2011, imaging the distal external iliac, common femoral, femoral, popliteal, posterior tibial, peroneal and anterior tibial veins. The great saphenous vein (GSV), small saphenous vein (SSV), anterior and posterior accessory saphenous veins (AASV and PASV), and perforator veins were evaluated for patency and reflux at multiple stations. The incidence and trends of various reflux patterns were examined. Results —A total of 1091 limbs of 593 patients were examined during this 10-month time period. Seventy-five limbs were excluded on the grounds of previous GSV harvest, stripping or ablation, limiting our analysis to 1016 limbs. Sixty-eight limbs (7%) revealed deep venous reflux without associated superficial reflux, 292 limbs (29%) revealed isolated superficial venous reflux, and 461 limbs (45%) revealed combined deep and superficial venous reflux. Of the 753 total limbs with superficial venous reflux, 528 limbs (70%) revealed “classic” reflux at the SFJ and 225 limbs (30%) revealed “accessory” superficial reflux without reflux at the SFJ. Of this “accessory” venous reflux cohort 76 limbs (34%) revealed GSV reflux caudal to the junction, 10 limbs (4%) revealed isolated AASV reflux, 20 limbs (9%) revealed isolated SSV reflux, 2 limbs (1%) revealed isolated PASV reflux, 10 limbs (4%) revealed perforator reflux exclusive of any other identified superficial venous reflux, and 106 limbs (47%) revealed a combination of accessory reflux patterns. Fifty-three of the 225 limbs with “accessory” venous reflux (24%) received surgical intervention in the form of “accessory” venous ablation or ligation, or 5% of the total patient population in this series. Conclusion —In summary, while the expanded venous reflux study requires more time and skill to perform, it reveals a cohort of patients with superficial venous insufficiency that may have previously been missed. Specifically, 225 limbs in our series (22% of the total series and 30% of limbs with superficial venous reflux) demonstrated “accessory” superficial venous reflux patterns without reflux at the SFJ which may have previously gone undiagnosed and thus untreated.

The Optimal Duration of Compression Therapy Following Varicose Vein Surgery: A Meta-analysis of Randomized Controlled Trials

The optimal duration of compression therapy following varicose vein surgery of the great saphenous vein (GSV) remains controversial. Therefore, the aim of this study was to evaluate different durations of compression therapy after varicose vein surgery and their outcomes. A systematic review and meta-analysis of randomized controlled trials (RCTs). Outcomes from short-duration (3-10 d) and long-duration (3-6 wk) compression therapy after GSV stripping and phlebectomies were evaluated. Pain was assessed post surgery using a visual analog scale. Secondary outcomes included leg volume, complications, and the duration of absenteeism from work. We identified 4 RCTs published between 1991 and 2009 that evaluated 686 patients. We observed non-significant differences in postoperative pain scores between the long-duration and short-duration groups, with a weighted mean difference of -0.03 (95% confidence interval (CI): -0.53 to 0.47) at 4 weeks, and -0.01 (95% CI: -0.31 to 0.33) at 6 weeks, postoperatively. We also observed non-significant differences in the incidence of postoperative complications (risk ratio: 0.84, 95% CI: 0.60-1.18), and changes in leg volume, 4 weeks postoperatively (P = .18) between the groups. Our study results indicate that there are no benefits to long-term compression therapy after varicose vein surgery of the GSV regarding postoperative pain, leg volume, incidence of complications, and duration of absenteeism from work.

The Influence of Residual Below-Knee Reflux and Incompetent Perforating Veins on Venous Function after Stripping Surgery

Persisting incompetent great saphenous vein (GSV) below the knee and residual incompetent perforating veins (IPV) are often found after selective stripping of GSV from the groin to upper calf. The aim of this study is to evaluate the venous function when the calf GSVs or calf perforating veins are incompetent after stripping surgery. One hundred-thirty-one limbs were treated by stripping from the groin to upper calf with stab avulsion or sclerotherapy of varices. One month and twelve months after surgery, the patients were examined clinically to establish the extent of persisting varices by duplex ultrasonography and air-plethysmography. Venous filling index (VFI) was a little higher in those who had residual calf GSV reflux 12 months later; it was also higher in the group with incompetent perforating veins than the group without. The chief complaints were found to have improved in all groups. The findings suggest that removal of the saphenous vein below the knee is not necessary, but it is important to take care of the incompetent perforating veins. (English Translation of Jpn J Phlebol 2011; 22: 239-244.).

Giacomini projection of the lesser saphenous vein and associated operative strategy in lesser saphenous vein stripping

Objectives: ‘Giacomini vein’ is the term used to describe the thigh extension branch of the lesser saphenous vein. It courses the posterior thigh as a trunk projection of the lesser saphenous vein. Although its existence has minor importance in majority of patients with varicose disease, missing its existence during the surgical treatment of varicosities of lesser saphenous vein may cause catastrophic results. In this article we aimed to present prevalence of Giacomini vein, and the strategies to prevent related undue complications. Materials and Methods: Between January 2011 and May 2013, Two hundred and fifteen patient records were reviewed retrospectively in order to investigate Giacomini vein prevalence in young adult patients who underwent venous surgery due to varicose veins. Data regarding the mean age of the patients, existence of varicose dilatation of Giacomini vein and association with lesser saphenous vein tortuosity, and common variations of Giacomini vein were analysed. Results: The age of patients were 21.54 ± 0.81 (min: 21, max: 25). A hundred and sixty-nine patients underwent great saphenous vein stripping plus venous pack extirpation, and twenty-eight patients underwent lesser saphenous vein stripping plus venous pack extirpation and eighteen patients underwent only venous pack extirpation. Conclusions: It should be kept in mind that saphenopopliteal junction level demontsrate variations. Missing this information may result in catastrophic complication such as popliteal vein tearing during lesser saphenous vein stripping in the presence of low-level saphenopopliteal junction.

Anatomical variations of saphenofemoral junction encountered during venous surgery

Objectives: The term, 'varicose veins' is used commonly to describe the enlargement and tortuosity of lower extremity veins. However varicose veins can occur elsewhere. The traditional surgical treatment has been vein stripping to remove the affected veins. In this article we aimed to present common anatomical variations of saphenofemoral junction encountered during surgical procedures in young adult patient population. Materials and Methods: Between January 2011 and January 2013, saphenofemoral junction compositions were investigated in 156 young adult patients who underwent great saphenous vein stripping with the diag- nosis of superficial venous insufficiency. Data regarding the mean age of the patients, venous side branches draining to the saphenofemoral junction, the number of bifid saphenous vein and the distance between saphe - nous vein bifurcation to the saphenofemoral junction were recorded. Results: The age of patients were 21.64 ± 0.91(min:21, max: 25) and the number of side branches draining to the saphenofemoral junction was 4.9 ± 1.6 (min:1, max:8). Branches draining directly to the common femoral vein at the level of junction were detected in 4 cases (2.56%). Bifid saphenous vein was observed in 9 cases (5.7%), and three of them were draining to the junction as a common trunk. Conclusions: It should be kept in mind that the success rate of the surgical procedure may be relevant to ana- tomical variation. To be familiar with the anatomical variations may decrease the recurrence rates of disease.

The impact of direction of great saphenous vein total stripping on saphenous nerve injury

To examine and compare the effects of downwards versus upwards total stripping of great saphenous vein (GSV) on saphenous nerve (SN) injury using clinical and electrophysiological studies. Fifty patients with varicosities were equally and randomly assigned to undergo total, upwards stripping (group A) or downwards stripping (group B) of GSV during saphenectomy. SN function was measured with electroneurogram (ENG) before operation, two weeks and 12 weeks after, in order to record the incidence and type of SN injury. Clinical signs of SN injury were also recorded at the same time points. The results were statistically analysed. There were no statistical significant differences on the occurrence of SN injury between groups A and B at two and 12 weeks, respectively, as confirmed with ENG studies and clinical evaluation. There were no differences between the two techniques with regard to the type of SN injury. SN injury was significantly ameliorated from 34% to 6% during the first three months. SN injury was equally observed after downwards or upwards total stripping of the GSV, as confirmed by ENG and clinical evaluation, with no differences in injury type. SN injury tends to be relieved through time in most patients.

Randomized clinical trial of ultrasound-guided foam sclerotherapy versus surgery for the incompetent great saphenous vein

New minimally invasive treatment modalities, such as ultrasound-guided foam sclerotherapy (UGFS), are becoming more popular. In a multicentre randomized controlled non-inferiority trial, the effectiveness and costs of UGFS and surgery for treatment of the incompetent great saphenous vein (GSV) were compared. Patients with primary great saphenous varicose veins were assigned randomly to either UGFS or surgical stripping with high ligation. Recurrence, defined as reflux combined with venous symptoms, was determined on colour duplex scans at baseline, 3 months, 1 year and 2 years after initial treatment. Secondary outcomes were presence of recurrent reflux (irrespective of symptoms), reduction of symptoms, health-related quality of life (EQ-5D(™)), adverse events and direct hospital costs. Two hundred and thirty patients were treated by UGFS and 200 underwent GSV stripping. The 2-year probability of recurrence was similar in the UGFS and surgery groups: 11·3 per cent (24 of 213) and 9·0 per cent (16 of 177) respectively (P = 0·407). At 2 years, reflux irrespective of venous symptoms was significantly more frequent in the UGFS group (35·0 per cent) than in the surgery group (21·0 per cent) (P = 0·003). Mean(s.d.) hospital costs per patient over 2 years were €774(344) per patient for UGFS and €1824(141) for stripping. At 2-year follow-up, UGFS was not inferior to surgery when reflux associated with venous symptoms was the clinical outcome of interest. UGFS has the potential to be a cost-effective approach to a common health problem. Registration numbers: NCT01103258 (http://www.clinicaltrials.gov) and NTR654 (http://www.trialregister.nl).

Varicose Vein Surgery

Chronic venous insufficiency (CVI) is a common vascular disorder that affects a significant proportion of the population in the United States and other developed countries. In its advanced stages, CVI significantly reduces patients’ quality of life and imposes a high economic burden on society due to increased direct health care costs and reduced productivity. Favorable clinical results associated with endovascular ablation techniques and patient preference for minimally invasive procedures has led to a shift in which treatment of vein disease is moving from the hospital to the office, allowing a more diverse group of physicians to enter a field that had typically been the domain of surgeons. This chapter reviews the terminology associated with venous disease, indications for varicose vein surgery, preoperative evaluation, procedural planning, endovenous procedures (endovenous laser ablation, radiofrequency ablation), surgical vein stripping techniques, and foam sclerotherapy. Tables include Clinical severity, Etiology or Cause, Anatomy, Pathophysiology classification; summary of nomenclature changes for the lower extremity venous system; indications for varicose vein surgery; interrogation points in the venous reflux examination; complications associated with treatment modalities used in the management of CVI; and methods of variceal ablation. Figures show an ultrasonographic image of a saphenous eye, placement of a quartz fiber for laser ablation of the great saphenous vein, a typical saphenofemoral junction, surgical stripping of the great saphenous vein, and microfoam sclerotherapy. This review contains 9 figures, 6 tables and 73 references.