title: Resecting the great saphenous stump with endothelial inversion decreases neither neovascularization nor thigh varicosity recurrence.
abstract: BACKGROUND
  Neovascularization at the saphenofemoral junction is one of the principal causes of recurrent varicose veins after great saphenous vein surgery. Because angiogenic stimulation from the exposed endothelium of the great saphenous vein stump is considered an important trigger for this process, we hypothesized that complete resection of the stump with endothelial inversion might lessen grade 2 groin neovascularization and thereby decrease recurrence of thigh varicosities.
  
  
  METHODS
  Two groups of consecutive patients with primary varicose veins of the great saphenous vein were studied. Group A was a historical control group of 70 limbs (48 patients) in which conventional flush ligation was performed at the level of the saphenofemoral junction. Group B was a prospectively studied clinical trial cohort of 65 limbs (45 patients), wherein the great saphenous vein stump was completely resected using a side-biting clamp to isolate the saphenofemoral junction, and the resulting common femoral vein venotomy was closed with a running inverting suture. Early postoperative follow-up was performed at 6 weeks. Clinical examinations and duplex ultrasound scans were performed after 2 years of follow-up. Grade 2 groin neovascularization was defined by the presence of >3 mm tortuous new refluxing veins, typically communicating with recurrent varicosities in the thigh.
  
  
  RESULTS
  After 2 years, recurrent varicose veins were present in the thighs of 13 of 65 limbs (20%) in group A and in 22 of 61 limbs (36%) of group B (P = .049). Grade 2 neovascularization was present at the saphenofemoral junction in six of 65 limbs (9%) of group A and in 12 of 61 limbs (20%) of group B (P = .127).
  
  
  CONCLUSIONS
  Complete resection of the great saphenous vein stump and inversion suturing of the common femoral vein venotomy, instead of simple flush ligation at the level of the saphenofemoral junction, do not appear to decrease grade 2 neovascularization and related thigh varicosity recurrence after great saphenous vein stripping for primary varicose veins.
authors: Department of Surgery, District Hospital of Frutigen, Frutigen, Switzerland. dominik.heim@spitalfmi.ch
authors: Dominik
authors: D
authors: Heim
authors: Marco
authors: M
authors: Negri
authors: Urs
authors: U
authors: Schlegel
authors: Marianne
authors: M
authors: De Maeseneer
mesh_terms: D000328:Adult; D004730:Endothelium, Vascular / Q000601:surgery*; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D006119:Groin / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D011446:Prospective Studies; D012008:Recurrence; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D013536:Suture Techniques; D013848:Thigh / Q000098:blood supply*; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*