The aim of the present study is to compare a mini-invasive (smaller than 2-cm incision) sapheno-femoral high-tie by clip apposition (HT group) with a traditional high-ligation by ligature (HL group).
Methods
One hundred fifty chronic venous disease patients were included in group HT and compared with 150 cases constituting the group HL. The main outcome was the sonographic detection of saphenous trunk recurrences. Procedural pain, esthetic satisfaction, and disease specific quality of life were assessed.
Results
At 4.5 ± 2.4 years follow-up, 8 cases (5.3%) of Great Saphenous Vein reflux reappearance were reported in group HT vs. 19 cases (12.6%) (odds ratio: 2.6; 95% confidence interval: 1.1–6.1; P = 0.04) of group HL. Esthetic satisfaction was scored as high and very high in group HT and HL, respectively (P < .0001).
Conclusions
Proper high-ligation technique provides satisfying outcomes both in terms of recurrence rate and patient esthetic satisfaction. The different outcomes obtained by the two groups encourage further investigations regarding recurrence pathogenesis.
NiedzwieckiG. Endovenous thermal ablation of the saphenous vein. Semin Intervent Radiol2005; 22: 204–208.
2.
GloviczkiPComerotaAJDalsingMC. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg2011; 53: 2S–48S.
3.
EnzlerMABisangUAmann-VestiB. Treatment of varicose veins with minimally invasive methods: is conventional surgery still a “gold standard”?Acta Chir Belg2010; 110: 263–266.
4.
PerrinM. Presence of varices after operative treatment: a review. Phlebolymphology2014; 21: 158–168.
5.
LynchNPClarkeMFultonGJ. Surgical management of great saphenous vein varicose veins: A meta-analysis. Vascular2015; 23: 285–296.
6.
BrakeMLimCSShepherdAC. Pathogenesis and etiology of recurrent varicose veins. J Vasc Surg2013; 57: 860–868.
7.
FischerRChandlerJGDe MaeseneerMG. The unresolved problem of recurrent saphenofemoral reflux. J Am Coll Surg2002; 195: 80–94.
8.
BerganJJ. Inversion stripping of the saphenous vein. The vein book, San Diego, CA: Elsevier Academic Press, 2007, pp. 231–239.
9.
WhiteleyAMTaylorDCDos SantosSJ. Pelvic venous reflux is a major contributory cause of recurrent varicose veins in more than a quarter of women. J Vasc Surg Venous Lymphat Disord2014; 2: 411–415.
10.
QuinnJVWellsGA. An assessment of clinical wound evaluation scale. Acad Emerg Med1998; 5: 583–586.
11.
CollAMAmeenJRMeadD. Postoperative pain assessment tools in day surgery: literature review. J Adv Nurs2004; 46: 124–133.
12.
KuetMLLaneTRAnwarMA. Comparison of disease-specific quality of life tools in patients with chronic venous disease. Phlebology2014; 29: 648–653.
13.
GianesiniSOcchionorelliSMenegattiE. CHIVA strategy in chronic venous disease treatment: instructions for users. Phlebology2015; 30: 157–171.
14.
MlosekRKWoźniakWGruszeckiL. The use of a novel method of endovenous steam ablation in treatment of great saphenous vein insufficiency: own experiences. Phlebology2014; 29: 58–65.
15.
EliasSLamYLWittensCH. Mechanochemical ablation: status and results. Phlebology2013; 28(Suppl 1): 10–14.
16.
van EekerenRRBoersmaDKonijnV. Postoperative pain and early quality of life after radiofrequency ablation and mechanochemical endovenous ablation of incompetent great saphenous veins. J Vasc Surg2013; 57: 445–450.
17.
Bootun R, Lane T, Dharmarajah B, et al. Intra-procedural pain score in a randomised controlled trial comparing mechanochemical ablation to radiofrequency ablation: The Multicentre Venefit™ versus ClariVein for varicose veins trial. Phlebology 2016; 31: 61–65.
FrulliniAFortunaD. Laser assisted foam sclerotherapy (LAFOS): a new approach to the treatment of incompetent saphenous veins. Phlebologie2013; 66: 51–54.
20.
AlmeidaJIJavierJJMackayEG. Two-year follow-up of first human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. Phlebology2015; 30: 397–404.
21.
KurdalATYildirimFOzbakkalogluA. Ultrasound-guided catheter-directed foam sclerotherapy for great saphenous vein. Minerva Chir2015; 70: 33–36.
22.
ProebstleTMAlmBJGöckeritzO. Five-year results from the prospective European multicentre cohort study on radiofrequency segmental thermal ablation for incompetent great saphenous veins. Br J Surg2015; 102: 212–218.
23.
NesbittCBedenisRBhattacharyaV. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database Syst Rev2014; 7: CD005624–CD005624.
24.
MeseBBozoglanOErogluE. Comparison of 1,470-nm endovenous laser ablation and radiofrequency ablation in the treatment of great saphenous veins 10 mm or more in size. Ann Vasc Surg2015; 29: 1368–1372.
25.
Bellmunt-MontoyaSEscribanoJMDilmeJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev2015; 6: CD009648–CD009648.
26.
GeierBStückerMHummelT. Residual stumps associated with inguinal varicose vein recurrences: a multicenter study. Eur J Vasc Endovasc Surg2008; 36: 207–210.
27.
MiloneMSalvatoreGMaiettaP. Recurrent varicose veins of the lower limbs after surgery. Role of surgical technique (stripping vs. CHIVA) and surgeon's experience. G Chir2011; 32: 460–463.
28.
MoutonWGMarklewitzMMFriedliS. Neovascularisation after surgery for recurrent saphenofemoral incompetence: does surgical dissection technique matter?Vasa2011; 40: 296–301.
29.
WinterbornRJFoyCHeatherBP. Randomised trial of flush saphenofemoral ligation for primary great saphenous varicose veins. Eur J Vasc Endovasc Surg2008; 36: 477–484.
30.
HeimDNegriMSchlegelU. Resecting the great saphenous stump with endothelial inversion decreases neither neovascularization nor thigh varicosity recurrence. J Vasc Surg2008; 47: 1028–1032.
31.
FringsNNelleATranP. Reduction of neoreflux after correctly performed ligation of the saphenofemoral junction. A randomized trial. Eur J Vasc Endovasc Surg2004; 28: 246–252.
32.
SaracAJahollariATalayS. Long-term results of external valvuloplasty in adult patients with isolated great saphenous vein insufficiency. Clin Interv Aging2014; 9: 575–579.
33.
GianesiniSMenegattiEZuoloM. Laser-assisted strategy for reflux abolition in a modified CHIVA approach. Veins Lymphat2015; 4: 53–57.
34.
FerracaniE. Internal laser valvuloplasty and venous remodelling using 1470 laser. Initial experience. Flebologia2013; 3: 39–40.
35.
OkazakiYOrihashiK. Less invasive ultrasonography-guided high ligation of great saphenous vein in endovenous laser ablation. Ann Vasc Dis2013; 6: 221–225.
36.
BootunRLaneTRDaviesAH. The advent of non-thermal, non-tumescent techniques for treatment of varicose veins. Phlebology2016; 31: 5–14.
37.
AtasoyMM. Efficacy and safety of endovenous laser ablation in very large and tortuous great saphenous veins. J Vasc Interv Radiol2015; 26: 1347–1352.
38.
LiangYJiaYZhangZ. A novel endovenous laser ablation strategy of treatment of greater saphenous vein varicosities with difficult wire placement. Lasers Med Sci2014; 29: 393–403.
39.
CarrollCHummelSLeavissJ. Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation. Health Technol Assess2013; 17. i-xvi, 1–141.
