Saphenous vein stripping and quality of outcome

Preliminary Results of PTFE Patch Saphenoplasty to Prevent Neovascularization Leading to Recurrent Varicose Veins

Objective:

Recurrence is common after varicose vein surgery. Neovascularization may be one cause of recurrent veins. This was a study of PTFE patch saphenoplasty to try and prevent recurrent veins.

Design and setting:

Prospective cohort study of patients treated in a vascular surgical unit.

Patients and interventions:

Fifty patients having surgery for symptomatic long saphenous varicose veins (66 legs, 51 primary and 15 recurrent veins) had a PTFE patch sutured over the saphenous opening after flush saphenofemoral ligation.

Main outcome measures:

The rate of varicose vein recurrence and neovascularization 1 year after surgery were determined using clinical examination and venous duplex imaging.

Results:

Forty patients (80%) remained pleased with the results of their surgery. Recurrent veins were visible in 14 (21%) legs: 10 were principally due to neovascularization, two to sapheno-popliteal incompetence and two to an incompetent mid-thigh perforating vein. Three other legs had neovascularization but no recurrent veins. Both recurrent veins (47% versus 14%) and neovascularization (40% versus 14%) were significantly more common in patients having surgery for recurrent veins.

Conclusions:

PTFE patching was safe but did not abolish neovascularization. Neovascularization was the principal cause of recurrent veins in this study and perseverance with investigations into other barrier methods is worthwhile.

Closure of the Cribriform Fascia: An Efficient Anatomical Barrier Against Postoperative Neovascularisation at the Saphenofemoral Junction? A Prospective Study

BACKGROUND

Neovascularisation at the sapheno-femoral junction (SFJ) ligation site in the groin may occur within one year after great saphenous vein (GSV) surgery. Several anatomical and prosthetic barrier techniques have been proposed to prevent this evolution.

OBJECTIVE

A prospective study examined whether closing the cribriform fascia could reduce the incidence of postoperative neovascularisation in the groin.

PATIENTS AND METHODS

Patients with primary varicose veins and incompetence at the level of the SFJ were included. After SFJ ligation in 235 limbs of 193 patients an anatomical barrier was constructed by closing the cribriform fascia. Postoperative duplex scanning was performed after 2 and 12 months. Results were compared with historical control groups in which either a silicone patch saphenoplasty or no barrier technique had been performed.

RESULTS

After one year, 10 limbs had developed recurrent thigh varicose veins and duplex scan showed neovascularisation at the SFJ ligation site in 15 of 223 re-examined limbs (6.7%). This was comparable to the group of 191 limbs with silicone patch saphenoplasty (5.2%) (P=0.526) and superior to the group of 189 limbs without barrier (14.8%) (P<0.01).

CONCLUSION

Interposition of an anatomical barrier by closing the cribriform fascia after SFJ ligation reduced ultrasound detected neovascularisation at the SFJ after one year. In primary varicose vein operations application of an anatomical barrier technique (without prosthetic patch) is an alternative option to prevent postoperative neovascularisation.