Functional repair of the great saphenous vein by external valvuloplasty reduces the vein's diameter: 6-month results of a multicentre study (original) (raw)
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Summary: Background: Varicosis of the great saphenous vein (GSV) is a common disease. Most of the therapeutic concepts attempt to remove or destroy the truncal vein. However, the absence of the GSV could be harmful for further treatments of artherosclerotic disease as the GSV is often used as bypass graft in lower extremity or coronary artery revascularisations. External valvuloplasty (EV) is one of the vein-sparing treatment options. The aim of this clinical study was to describe the outcome, safety and complications of this procedure in a prospective multicentre trial. Patients and methods: The function of the terminal and preterminal valve was restored by external valvuloplasty. Furthermore, multiple phlebectomies of tributaries were performed. Patients were reinvestigated six weeks after surgery. Primary endpoint was the function of the external valvuloplasty measured by diameter of the GSV and the prevalence of reflux in the GSV. The eligibility of the vein as a potential bypas...
Clinical Interventions in Aging, 2014
Objective: The aim of this study is to present our 7-year results of external valvuloplasty for isolated great saphenous vein (GSV) insufficiency. Methods: External 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. Results: A 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. Conclusion: External 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.
The effect of valvulotomy on the flow rate through the saphenous vein graft: Clinical implications
Journal of Vascular Surgery, 1988
Potential differences in flow rates between reversed and in situ saphenous vein bypass grafts were evaluated. One hundred ten greater saphenous vein segments containing isolated valves were examined with fiber-optic angioscopy during pulsatile and nonpulsatile flow. Valve competency was determined, and the degree of luminal obstruction caused by the valve during reversed flow was calculated with caliper measurements of the video image. Flow measurements were obtained before and after valvallotomy, in reversed and nonreversed vein orientations. Increased flow rates occurred during pulsatile irrigation only, after vahatlotomy in vein segments with diameters less than 2.5 mm (p < 0.001, Bonferroni t test). In these small-diameter vein segments, the flow rate in reversed valve-intact vein was 94.4-28.9 ml/min (mean-1 standard deviation), the flow rate in reversed valve-disrupted vein was 136.4-+ 36.5 ml/min, and the flow rate in nonreversed valve-disrupted vein was 137.8-31.3 ml/min. In 22 vein segments, luminal obstruction caused by the intact valve was measured angioscopically. A small valve orifice was found to be related to a large increase in flow rate after valvulotomy (p < 0.02, least-squares regression). In addition, veins with diameters less than 2.5 m m have significantly smaller valve orifices compared with veins with diameters greater than 2.5 mm. These results present important clinical implications as the number of distal extremity reconstructions increases.
Great saphenous varicose vein surgery without saphenofemoral junction disconnection
British Journal of Surgery, 2010
Background:The aim of this case–control study was to determine whether preoperative duplex imaging could predict the outcome of varicose vein surgery without saphenofemoral junction (SFJ) disconnection. The duplex protocol included a reflux elimination test (RET) and assessment of the competence of the terminal valve of the femoral vein.The aim of this case–control study was to determine whether preoperative duplex imaging could predict the outcome of varicose vein surgery without saphenofemoral junction (SFJ) disconnection. The duplex protocol included a reflux elimination test (RET) and assessment of the competence of the terminal valve of the femoral vein.Methods:One hundred patients with chronic venous disease who had a positive RET result and an incompetent terminal valve were compared with 100 patients matched for age, sex, clinical class (Clinical Etiologic Anatomic Pathophysiologic (CEAP) class C2–C6) and disease duration, but who had a positive RET result and a competent terminal valve. All patients underwent ligation and proximal avulsion of the incompetent tributaries from the great saphenous vein trunk without SFJ disconnection. Clinical and duplex follow-up lasted for 3 years, and included Hobbs' clinical score.One hundred patients with chronic venous disease who had a positive RET result and an incompetent terminal valve were compared with 100 patients matched for age, sex, clinical class (Clinical Etiologic Anatomic Pathophysiologic (CEAP) class C2–C6) and disease duration, but who had a positive RET result and a competent terminal valve. All patients underwent ligation and proximal avulsion of the incompetent tributaries from the great saphenous vein trunk without SFJ disconnection. Clinical and duplex follow-up lasted for 3 years, and included Hobbs' clinical score.Results:Of legs with a competent terminal valve, 100 per cent were rated as cured (Hobbs' class A or B) and 14·0 per cent developed recurrent varices. Patients with an incompetent terminal valve had significantly worse results: 29·0 per cent had Hobbs' class A or B and 82·0 per cent developed recurrence (P < 0·001).Of legs with a competent terminal valve, 100 per cent were rated as cured (Hobbs' class A or B) and 14·0 per cent developed recurrent varices. Patients with an incompetent terminal valve had significantly worse results: 29·0 per cent had Hobbs' class A or B and 82·0 per cent developed recurrence (P < 0·001).Conclusion:Preoperative duplex assessment of the terminal valve could be used to identify patients suitable for varicose vein surgery without the need for SFJ disconnection. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.Preoperative duplex assessment of the terminal valve could be used to identify patients suitable for varicose vein surgery without the need for SFJ disconnection. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Use of a Novel Device in Reconstructive Venous Surgery: Preliminary Results
International Journal of Angiology, 2020
Evaluation of the outcomes of OSES (oval-shaped external support), a novel device for external valvuloplasty of the great saphenous vein (GSV) for the conservative treatment of superficial venous insufficiency. Between 2012 and 2015, 30 patients underwent external valvuloplasty of the GSV for a total of 32 limbs. Patients were subjected to clinical and instrumental follow-up by a half-year ultrasound for a minimum of 36 months. The main endpoints were the recurrence of varicose disease, persistent or recurrent venous reflux, and venous thrombosis. Varicose recurrence was verified in six limbs on 32 (18.75%). Four limbs (12.5%) presented a recurrence of the reflux even in the absence of varicose veins. Two limbs (6.25%) underwent saphenectomy after the valvuloplasty intervention at 12 and 18 months, respectively, because of the presence of saphenofemoral reflux and varicose recurrences. No case of venous thrombosis of the saphenous trunk was observed. The external valvuloplasty of th...
Journal of Vascular Surgery, 1993
Purpose: There is controversy in the surgical management of varicose veins between stripping of the long saphenous vein (LSV) and high ligation. 1 Moreover, preservation of the LSV is desirable for future coronary or peripheral artery bypass. We have studied 75 limbs in 44 patients after high saphenous figation with multiple stab phlebectomy. Methods: Subjective assessment of the outcome of surgery was made with a linear analog scale, and objective cosmetic outcome was assessed by an independent observer (IF) who had not been involved in the surgical treatment of these patients with our modification from the criteria first described by Jakobsen. 2 Patency, length, and diameter of the LSV was measured 6 to 14 months (mean 12 months) after operation with a duplex scanner and a color-flow scanner. Valvular incompetence in the LSV and perforators was also assessed. Results: Results show a good subjective and objective outcome in 95% and 97% of limbs, respectively. The LSVs were patent from ankle to groin in 68% and from ankle to knee in 82%, with a mean diameter of 4.0 ± 0.1 nun (mean ± SEM). There was no statistically significant difference in symptomatic outcome and presence of reflux in the LSV (X 2 = 0,465; p = 0.4954; NS) or objective cosmetic outcome and the presence of reflux in the LSV (X 2 = 2.916; p = 0.0877; NS). Conclusions: It is concluded that high saphenofemoral ligation combined with multiple "stab avulsions" preserves an LSV with characteristics suggesting suitability for future use as a vascular prosthesis with good early symptomatic and cosmetic results.
Editor's Choice - Five Year Results of Great Saphenous Vein Treatment: A Meta-analysis
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2017
The most frequently used treatment options for great saphenous vein incompetence are high ligation with stripping (HL+S), endovenous thermal ablation (EVTA), mainly consisting of endovenous laser ablation (EVLA) or radiofrequency ablation, and ultrasound guided foam sclerotherapy (UGFS). The objective of this systematic review and meta-analysis was to compare the long-term efficacy of these different treatment modalities. A systematic literature search was performed. Randomised controlled trials (RCTs) with follow-up ≥ 5 years were included. Pooled proportions of anatomical success, which was the primary outcome, rate of recurrent reflux at the saphenofemoral junction (SFJ), and mean difference in venous clinical severity score (VCSS) were compared using a z test or Student t test. Quality of life data were assessed and described. Three RCTs and 10 follow-up studies of RCTs were included of which 12 were pooled in the meta-analysis. In total, 611 legs were treated with EVLA, 549 wit...
Anatomical basis of an original pedal approach to the great saphenous vein for surgery
Surgical and Radiologic Anatomy, 2006
Varicose vein repair often necessitates a distal approach to the great saphenous vein (GSV). The classic method involves a medial pre-malleolar approach. We propose a more distal approach via the medial surface of the foot where there is a cutaneous landmark, which can be used to locate the GSV in a simple, reliable and reproducible fashion. In 20 cadaveric feet, we dissected out the GSV exploiting the above-mentioned cutaneous landmark. We then extended the dissection up as far as the medial pre-malleolar region (from where the GSV is classically approached) in order to be able to compare the diameter of the vein at the two different points (in the foot and in the pre-malleolar region). We also compared the cutaneous landmark with ultrasonographic location of the GSV in 22 feet of healthy subjects. Both dissections and ultrasound examinations demonstrated the reliability of the cutaneous landmark. Moreover, no significant difference was detected in the diameter of the GSV at the two different approach points. This original distal approach to the GSV requires only minor modifications of current practice for varicose veins surgical treatment.
Veins and Lymphatics, 2014
Before developing deep venous thrombosis (DVT), most patients suffering from postthrombotic syndrome (PTS) have a normal great saphenous vein (GSV). After DVT, the GSV plays a vicarious function, but many patients develop secondary varicose veins (VVs) and the previous positive contribution of the GSV vanishes. In these cases the ablative strategy is generally implemented with positive results in the short-term, but commonly with late varicose recurrences. In two cases the authors preferred a different approach to preserve and recover the GSV vicarious function by sapheno-femoral junction (SFJ) valvuloplasty. Out of 43 cases we treated with SFJ stretching valvuloplasty performed with the new OSES device (V-OSES), we proposed this operation to two patients (A and B) suffering from PTS and secondary VVs at an early stage, classified as C3 and C4 (Clinical-Etiology-Anatomy-Pathophysiology classification, CEAP). In the V-OSES operation a gentle stretching force is applied onto the apex of the opposite valve commisures so that the valve cross-section becomes oval and the cusp's length excess is retrieved. The operation was performed on the SFJ valve having incompetent, but floating cusps visible on ultrasound (US) scan. This reparative technique was undertaken under local anesthesia and was combined with disconnection of the incompetent tributaries and/or perforators. The US-duplex scanning showed that the SFJ valves were competent at month 16 (B) and 20 (A) follow-up after surgery and the GSV vicarious function was preserved. The stretching valvuloplasty operation is intended to repair the SFJ valve incompetence and preserve the GSV vicarious function. This approach may be useful in primary VVs, but especially in PTS when superficial reflux appears and secondary VVs are at early stage. The SFJ reparative operation may be combined with the conventional GSV conservative strategies, including incompetent tributaries ablation/disconnection. This approach does not seem to have been already reported in the literature and needs further confirmation.