DISSERTATION ABSTRACT
Varicose vein surgery with preservation of the great saphenous vein: assessment of long-term results in patients treated by flush ligation of the saphenofemoral junction
Hamilton Almeida Rollo
Professor, Vascular Surgery, Department of Surgery and Orthopedics, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil. Head, Vascular Surgery Module, Faculdade de Medicina de Botucatu, UNESP, Botucatu, SP, Brazil. Head, Vascular Laboratory, Hospital das Clínicas, Faculdade de Medicina de Botucatu, UNESP, Botucatu, SP, Brazil.
ABSTRACT
INTRODUCTION: The great saphenous vein (GSV) is the best conduit for arterial bypass in lower limb revascularization, and has been used in coronary bypass surgery, in vascular trauma of the extremities, in venous reconstruction for patients with chronic venous insufficiency and as vascular access for hemodialysis. Therefore, in surgical treatment of primary varicose veins, preservation of the GSV is recommended whenever possible. The published results of surgical techniques for GSV preservation are still contradictory and there is a need for studies that provide a better assessment of these techniques.
OBJECTIVE: Evaluation of the mid- to long-term results of GSV-sparing surgical technique in patients with primary varicose veins of the lower limbs and GSV insufficiency due to reflux at the saphenofemoral junction (SFJ).
METHODS: This was a longitudinal study of a case series from the Vascular Surgery Center at the Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (UNESP), São Paulo, Brazil. All patients had primary varicose veins with GSV insufficiency and reflux at the SFJ. The operating technique consisted of flush ligation of the GSV, preserving the terminal tributaries and the trunk of the GSV. Varicose veins were removed through multiple stab incisions with a crochet needle. Before and after surgery, the patients were evaluated by means of clinical examination, photoplethysmography and color duplex scanning (CDS). With CDS the diameter of the GSV was assessed at five points, two in the thigh, two in the leg, and one at the knee. In one subset of patients (39) long-term results (> 5 years) of surgery were evaluated.
RESULTS: Seventy-seven limbs of 67 patients were studied, 34 limbs less than 5 years and 43 limbs more than 5 years after surgery. In 82.3% of the limbs, GSV diameters had significantly decreased after the operation (p < 0.05) and this decrease in diameter was maintained over the long term. The patency of the GSV after surgery was 91% and only 9% had thrombophlebitis. Recurrent saphenofemoral reflux after operation occurred in 5.9% of limbs in the group < 5 years and in 18.6% in those > 5 years, a difference that was not significant (p > 0.05). In the majority of preserved GSV, flow was observed in both directions with low velocities. The patients had excellent or good clinical outcomes (79.4%), even at later examinations. The recurrence of varicose veins was 35.3% (more frequent in legs) and there was significant impairment (p < 0.05) at long-term examination (69.8%). Photoplethysmography was carried out at the final evaluation of 69 limbs and in 85.7% of these the result was normal and there was no statistical difference between the groups studied before and after 5 years. Photoplethysmography was abnormal in 73.3% of the patients with recurrent varicose veins (p < 0.05).
CONCLUSION: The GSV-sparing surgical technique proved capable of preserving the vein in a condition suitable for future bypass surgery in the majority of limbs and the GSV continued to be adequate over long-term follow-up.
Keywords: Varicose veins, great saphenous vein, ultrasonic, plethysmography, surgery.
Manuscript received April 10, 2008, accepted August 04, 2008.
This dissertation was carried out as part of the Vascular Surgery Module and presented to the Department of Surgery and Orthopedics at Faculdade de Medicina de Botucatu (FMB), Universidade Estadual de São Paulo (UNESP), Botucatu, SP, Brazil, on March 19, 2008.
Examiners: Prof. Dr. Francisco Humberto de Abreu Maffei, Profa. Dra. Maria Aparecida Coelho de Arruda Henry, Prof. Dr. Emil Burihan, Prof. Dr. Carlos Eli Piccinato, Profa. Dra. Ana Terezinha Guillaumon.
Publication Dates
-
Publication in this collection
17 Dec 2008 -
Date of issue
Sept 2008
