title: Haemodynamic strategy for treatment of diastolic anterograde giacomini varicose veins.
abstract: OBJECTIVE
  To assess the diagnosis and outcome of a haemodynamic strategy for the treatment of primary varicose veins associated with anterograde diastolic flow (ADF) in the Giacomini vein (GV).
  
  
  METHODS
  ADF in the GV, with the escape point located at the saphenopopliteal junction, was demonstrated in 15 patients (15 limbs) by duplex ultrasound. No other escape points were seen in this group. ADF was defined as the flow present in the relaxing phase after isometric contraction of the lower limb, measured in the standing position. Duplex and clinical follow-up was performed prospectively at 1 week, at 1, 3, 6, and 12 months and once per year thereafter, between 1998 and 2001. Surgery consisted of flush division of the GV from the small saphenous vein (SSV) and division of the incompetent collateral veins from the GV.
  
  
  RESULTS
  GV diameter showed an average reduction from 6 to 4 mm 33 months after surgery. Fourteen patients (93%) showed no symptoms or varicose veins. GV reconnection and recurrent ADF was demonstrated in two patients (13%).
  
  
  CONCLUSIONS
  ADF is a rare condition associated with primary varicose veins. ADF occurs when there is a closed venovenous shunt with recirculation in the muscular diastole. This implies that, although a part of the circuit is ascendant, the re-entry point must be located downstream to the escape point. Accurate duplex assessment is required to distinguish this atypical haemodynamic condition from an abnormal systolic circuit bypassing a deep vein obstruction. Interruption of the GV above its junction with the SSV abolished ADF with an acceptable rate of recurrences.
authors.affiliation: Department of Angiology and Vascular/Endovascular Surgery, Hospital General Vall d'Hebron, UAB, barcelona, Spain. josemariaescribano@telefonica.net
authors.forename: J M
authors.initials: JM
authors.lastname: Escribano
authors.forename: J
authors.initials: J
authors.lastname: Juan
authors.forename: R
authors.initials: R
authors.lastname: Bofill
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez-Mori
authors.forename: J
authors.initials: J
authors.lastname: Maeso
authors.forename: J M
authors.initials: JM
authors.lastname: Fuentes
authors.forename: M
authors.initials: M
authors.lastname: Matas
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology; D005500:Follow-Up Studies; D006801:Humans; D011152:Popliteal Vein / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods*