High Tie with Sclerotherapy for Saphenous Vein Insufficiency

Abstract

The long-term results after treatment of primary varicose veins with a combination of compression sclerotherapy (CST) and high tie of the incompetent long saphenous vein were studied. Sixty-three legs in 60 patients were operated on. Subjective (by the patient), objective (by the surgeon) and functional (by foot volumetry) assessments were performed just after treatment, 6 months and 1, 3 and 5 years later. The immediate subjective results were excellent but objectively 21% of the patients still had residual varicosities. After 5 years 50% were subjectively well but only 16% of the legs were objectively cured. Among the foot volumetric parameters the expelled volume (EV; ml) and refilling flow/relative expelled volume ratio (Q/EV_rel; min⁻¹) best reflected the functional state. Mean EV increase was 56% after treatment but only 16% after 5 years. Q/EV_rel normalized initially but deteriorated after 1 year. No significant improvement in any parameter was observed after 5 years. CST combined with high tie cannot replace surgery in patients with main stem insufficiency. The results emphasize the importance in following these patients for at least 5 years. On the whole, functional evaluation with foot volumetry was valuable to assess groups but could not replace the examination of individual patients.