Treatment of Primary Venous Insufficiency by Endovenous Saphenous Vein Obliteration

Abstract

The objective of this paper is to evaluate treatment of primary venous insufficiency by endovenous saphenous vein obliteration. Three hundred one limbs were treated in 206 women and 67 men with a mean CEAP Clinical Class of 2.4 ±0.9. Endovenous obliteration was combined with high ligation in 67 limbs (22%) and with stab avulsion phlebectomies in 181 (60%). Acute occlusion was achieved in 290 limbs (96%). Obliteration failures in 11 limbs were treated by saphenous stripping or managed expectantly. Paresthesias followed 15% of treatments confined to the thigh and upper leg and affected 30% of limbs when treatment extended to the ankle (p < 0.001). Eight potentially preventable thermal skin injuries occurred, five in particularly superficial venous segments, of which four were in men. At a mean follow-up of 4.9 months, 21 (7.2%) of successfully treated veins have partially or totally (n = two) recanalized, but only 11 (3.8% of 290) have Doppler-detectable reflux. Ninety-one patients have been followed up for 6 months to 1 year, showing significant improvement in CEAP class and progressive relief from clinical symptoms. At their latest visit, 94% rated themselves as being symptom-free or substantially improved. These midterm results with endovenous obliteration in the treatment of primary varicose veins suggest that it may be as effective as surgical stripping in eliminating greater saphenous vein reflux and delaying the appearance of new varicose veins. Simple procedural modifications, such as not treating to the ankle, prophylactic infiltration about superficially placed veins, and early duplex surveillance should diminish the complications observed in this early experience.

Get full access to this article

View all access options for this article.

References

1. Walsh JC , Bergan JJ , Beeman S , et al: Femoral venous reflux abolished by greater saphenous vein stripping. Ann Vasc Surg 8 :566-570, 1994.

2. Labropoulos N , Delis K , Nicolaides AN , et al: The role of the distribution and anatomic extent of reflux in the development of signs and symptoms in chronic venous insufficiency. J Vasc Surg 23:504-510, 1996.

3. Evans CJ , Allan PL , Lee AJ , et al: Prevalence of venous reflux in the general population on duplex scanning: The Edinburgh vein study. J Vasc Surg 28:767-776, 1998.

4. Sales CM , Bilof ML , Petrillo KA , et al: Correction of lower extremity deep venous incompetence by ablation of superficial venous reflux. Ann Vasc Surg 10:186-189, 1996.

5. Dwerryhouse S , Davies B , Harradine K , et al: Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: Five-year results of a randomized trial. J Vasc Surg 29:589-592, 1999.

6. Ricci S : Ambulatory phlebectomy. Principles and evolution of the method. Dermatol Surg 24:459-464, 1998. 213 Vascular Surgery May/June 2000

7. Cornu-Thenard A , Boivin P : Treatment of varicose veins by sclerotherapy: An overview. In: Varicose Veins and Telangiectasias, Diagnosis and Treatment, ed. 2, ed. by Goldman MP , Weiss RA , Bergan JJ . St Louis: Quality Medical Publishing, Inc, 1999, pp 225-246.

8. World Medical Association Declaration of Helsinki: Recommendations guiding physicians in biomedical research involving human subjects, adopted by the 18th World Medical Assembly, Helsinki, Finland, June 1964, amended by the 29th World Medical Assembly, Venice, Italy, October 1983 and the 41st World Medical Assembly, Hong Kong, September 1989.

9. Porter JM , Moneta GL , and an International Consensus Committee on Chronic Venous Disease: Reporting standards in venous disease: An update. J Vasc Surg 21:635-645, 1995.

10.

10. Hays WL : Some order methods. In: Statistics, ed. 4. New York: Harcourt Brace, 1991, pp 827-832.

11.

11. Cutler SJ , Ederer F : Maximum utilization of the lifetable method in analyzing survival. J Chronic Dis 8:699-712, 1958.

12.

12. Chen SS , Wright NT , Humphrey JD : Heat-induced changes in the mechanics of a collagenous tissue: Isothermal, isotonic shrinkage. J Biomech Eng 120:382-388, 1998.

13.

13. Holme JB , Holme K , Sorensen LS : The anatomic relationship between the long saphenous vein and the saphenous nerve. Relevance for radical varicose vein surgery. Acta Chir Scand 154:631-633, 1988.

14.

14. Jakobsen BH : The value of different forms of treatment for varicose veins. Br J Surg 66:182-184, 1979.

15.

15. Munn SR , Morton JB , Macbeth WA , et al: To strip or not to strip the long saphenous vein? A varicose veins trial. Br J Surg 68:426-428, 1981.

16.

16. Hammarsten J , Pedersen P , Cederlund C-G , et al: Long saphenous vein saving surgery for varicose veins. A long-term follow-up. Eur J Vasc Surg 4:361-364, 1990.

17.

17. Sarin S , Scurr JH , Coleridge Smith PD : Stripping of the long saphenous vein in the treatment of primary varicose veins. Br J Surg 81;1455-1458, 1994.

18.

18. Neglen P , Einarsson E , Eklof B . The functional longterm value of different types of treatment for saphenous vein incompetence. J Cardiovasc Surg 34:295-301, 1993.

19.

19. Rutgers PH , Kitslaar PJEHM : Randomized trial of stripping versus high ligation combined with sclerotherapy in the treatment of the incompetent greater saphenous vein. Am J Surg 168:311-315, 1994.

20.

20. Edmunds LH Jr , Clark RE , Cohn LH , et al: Guidelines for reporting morbidity and mortality after cardiac valvular operations. J Thorac Cardiovasc Surg 96:351-353, 1988.

21.

21. Jones L , Braithwaite BD , Selwyn D , et al: Neovascularisation is the principal cause of varicose vein recurrence: Results of a randomised trial of stripping the long saphenous vein. Eur J Vasc Endovasc Surg 12:442-445, 1996.

22.

22. Sarin S , Scurr JH , Coleridge Smith PD : Assessment of stripping the long saphenous vein in the treatment of primary varicose veins. Br J Surg 79:889-893, 1992.

23.

23. Nyamekye I , Shephard NA , Davies B , et al: Clinicopathological evidence that neovascularisation is a cause of recurrent varicose veins. Eur J Vasc Endovasc Surg 15:412-415, 1998.