Saphenofemoral Junction Ligation Supplemented by Postoperative Sclerotherapy: A Review of Long-Term Clinical and Hemodynamic Results

Abstract

This review article summarizes information found in the literature concerning long-term results following high ligation supplemented in the postoperative period by sclerotherapy. Subjective complaints, recurrent reflux, and recurrent varicose vein rates as well as changes in venous hemodynamics are reviewed and compared with results after high ligation and stripping. The fate of the greater saphenous vein trunk after high ligation, the question whether it could actually be used as a graft in arterial and coronary artery reconstructions, and the relevance of saphenous vein saving surgery are discussed. The trunk of the greater saphenous vein, when incompetent preoperatively, continues to be patent and incompetent after surgery in most cases. It is not diffusely degenerated and could be used as an arterial substitute. However, ligation of the saphenofemoral junction alone provokes a higher recurrence rate in comparison with high ligation and stripping. The excellent hemodynamic improvement achieved immediately after high ligation deteriorates progressively during the follow-up owing to recurrent reflux. Sclerotherapy can compensate this undesirable feature, because it is itself capable of reducing or even abolishing reflux and improving venous hemodynamics, although only transitorily, but repeated sclerosing injections can restore improvement at any time, if necessary, during the follow-up period. The improvement of venous hemodynamics and subjective symptoms achieved with the combined procedure (high ligation plus sclerotherapy) is comparable with that after high ligation and stripping.