Subfascial ligation at three different levels versus partial exeresis of the incompetent short saphenous vein: a randomized clinical trial.
OBJECTIVE
The study's objective was to compare subfascial ligation at three different levels and partial exeresis of the short saphenous vein for persistence of a reflux route and patients' subjective improvement of symptoms.


METHODS
A prospective randomized clinical trial was conducted.


METHODS
Eighty-four limbs with incompetent short saphenous veins were randomized for subfascial ligation at three different levels (n = 44) or partial exeresis (n = 40). Duplex ultrasound was performed preoperatively and postoperatively. The short saphenous vein was mapped before surgery. The patients' symptoms were documented before and after surgery. The Student t test and chi(2) test were used to calculate differences between the two treatment groups. Logistic regression analyses were performed to determine predictive values for the primary outcome measures: persisting reflux route and patients' subjective improvement after surgery.


RESULTS
Patients' characteristics and previous and additional surgical intervention were not significantly different between the two treatment groups (chi(2) test). Postoperative duplex sonography showed reflux in 64 limbs (76%). Improvement of symptoms was demonstrated in 57 cases (68%). There was no significant difference in the persistence of reflux or patients' improvement of symptoms between the two treatment groups.


CONCLUSIONS
Our study showed poor technical results after subfascial ligation at three different levels or partial exeresis of the short saphenous vein. No significant differences in the persistence of a reflux route and patients' subjective improvement of symptoms between both treatments were demonstrated. Routine postoperative monitoring with duplex ultrasound would facilitate the surgical techniques, and anatomic knowledge of all variations of the saphenopopliteal junction is needed.
Dumas
Bertien E
BE
Department of Surgery, Ikazia Hospital, Rotterdam; Capgemini Netherlands BV, Utrecht, The Netherlands.
Spronk
Sandra
S
Boelhouwer
Roelof U
RU
den Hoed
Pieter T
PT
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods / Q000523:psychology; D001294:Attitude to Health; D015984:Causality; D002908:Chronic Disease; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008026:Ligation / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011182:Postoperative Care; D011446:Prospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014689:Venous Insufficiency / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*