Great saphenous varicose vein surgery without saphenofemoral junction disconnection.
BACKGROUND
The aim of this case-control study was to determine whether preoperative duplex imaging could predict the outcome of varicose vein surgery without saphenofemoral junction (SFJ) disconnection. The duplex protocol included a reflux elimination test (RET) and assessment of the competence of the terminal valve of the femoral vein.


METHODS
One hundred patients with chronic venous disease who had a positive RET result and an incompetent terminal valve were compared with 100 patients matched for age, sex, clinical class (Clinical Etiologic Anatomic Pathophysiologic (CEAP) class C2-C6) and disease duration, but who had a positive RET result and a competent terminal valve. All patients underwent ligation and proximal avulsion of the incompetent tributaries from the great saphenous vein trunk without SFJ disconnection. Clinical and duplex follow-up lasted for 3 years, and included Hobbs' clinical score.


RESULTS
Of legs with a competent terminal valve, 100 per cent were rated as cured (Hobbs' class A or B) and 14.0 per cent developed recurrent varices. Patients with an incompetent terminal valve had significantly worse results: 29.0 per cent had Hobbs' class A or B and 82.0 per cent developed recurrence (P < 0.001).


CONCLUSIONS
Preoperative duplex assessment of the terminal valve could be used to identify patients suitable for varicose vein surgery without the need for SFJ disconnection.
Zamboni
P
P
Vascular Diseases Centre, Department of Surgery, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy. zmp@unife.it
Gianesini
S
S
Menegatti
E
E
Tacconi
G
G
Palazzo
A
A
Liboni
A
A
D000556:Ambulatory Surgical Procedures; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D005268:Femoral Vein / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012008:Recurrence; D012501:Saphenous Vein / Q000601:surgery*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D014689:Venous Insufficiency