title: Reflux elimination without any ablation or disconnection of the saphenous vein. A haemodynamic model for venous surgery.
abstract: OBJECTIVE
  to investigate the possibility of the haemodynamic suppression of reflux in the greater saphenous vein (GSV) without any high ligation and/or stripping procedure.
  
  
  METHODS
  prospective study; single group of patients.
  
  
  METHODS
  forty patients affected by primary chronic venous insufficiency of all clinical classes, with demonstrated duplex incompetence both of the sapheno-femoral junction (SFJ) and the GSV trunk, with the re-entry perforator located on a GSV tributary. The re-entry point was defined as the perforator, whose finger compression of the superficial vein above its opening eliminates reflux in the GSV.
  
  
  METHODS
  air-plethysmographic parameters as well as duplex scanning were performed both preoperatively, and 1 and 6 months later, respectively. Operation consisted in flush ligation and division from the GSV of the tributary containing the re-entry perforating vein.
  
  
  RESULTS
  duplex investigation demonstrated both a forward flow and reflux disappearance in the GSV in 100% and 85% of the cases after 1 and 6 months, respectively. All air-plethysmographic parameters, with the exception of Ejection Fraction, improved significantly: Venous Volume changed from 150+/-9 ml to 114+/-7 ml (p <0.0001), Venous Filling Index from 4.9+/-0.5 ml/s to 2.3+/-0.2 ml/s ( p <0.0001), and Residual Volume Fraction from 42+/-3 ml to 30+/-2 ml ( p <0.0001).
  
  
  CONCLUSIONS
  this study demonstrates that reflux in the GSV system is supported by a gradient of pressure between the anatomical point of reflux and the point of re-entry in the deep veins. Disconnection of the flow to the re-entry perforator without high ligation of the sapheno-femoral junction suppresses GSV reflux.
authors.affiliation: Department of Surgery and Vascular Laboratory, University of Ferrara, Ferrara, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Zamboni
authors.forename: C
authors.initials: C
authors.lastname: Cisno
authors.forename: F
authors.initials: F
authors.lastname: Marchetti
authors.forename: D
authors.initials: D
authors.lastname: Quaglio
authors.forename: P
authors.initials: P
authors.lastname: Mazza
authors.forename: A
authors.initials: A
authors.lastname: Liboni
mesh_terms: D000704:Analysis of Variance; D002908:Chronic Disease; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012501:Saphenous Vein / Q000601:surgery*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014689:Venous Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*