title: Saphenofemoral junction ligation and disconnection for varicose veins-a longitudinal study of cosmesis and function.
abstract: BACKGROUND
  Saphenofemoral junction ligation and disconnection (SFJLD) can be performed without exceeding the safe limits of local anesthetic if stripping of the long saphenous vein is not routine. We studied the early cosmetic and functional outcome of this procedure to identify the optimum time gap from SFJLD to multiple stab avulsions for varicose veins (VV).
  
  
  METHODS
  A series of patients with primary VV underwent SFJLD under local anesthetic as day case procedures. The volume of VV was quantified with a cartograph wheel, whereas the extent and severity of VV was assessed with four validated questionnaires: (a) Clinical Etiology Anatomy Pathology Score, (b) Venous Clinical Severity Score, (c) Aberdeen Varicose Vein Severity Score, and (d) Short Form 36. Patients were assessed preoperatively, and at 1, 3, and 6 months postoperatively. The analysis of variance for repeated measures test was used; a p value <0.05 was found to be significant.
  
  
  RESULTS
  There were 48 patients (15 men; mean age: 54 years; 95% CI: 29-79). In all, 91% (n = 44) of patients had cosmetic and symptomatic improvement. The volume of VV reduced significantly over the three postoperative time points when compared with preoperatively (112 [95% CI: 88-136] vs. 75 [95% CI: 55-97] vs. 65 [95% CI: 43-87] vs. 58 [95% CI: 31-86], p = 0.001). Using the Clinical Etiology Anatomy Pathology, Venous Clinical Severity Score, and Aberdeen Varicose Vein Severity Score questionnaires, severity of VV improved postoperatively when compared withpreoperatively (p = 0.001 respectively). Improvements in quality of life were also noted postoperatively with the Short Form 36 questionnaire (p = 0.032). At maximum follow-up of 3 years, 13% (n = 6) had recurrent VV.
  
  
  CONCLUSIONS
  SFJLD confers cosmetic and symptomatic improvement at 1 month. Improvement is sustained on early follow-up, thereby allowing multiple stab avulsions to be performed as a staged procedure within 6 months. The rates of recurrent VV are acceptable on short-term follow-up.
authors.affiliation: Scarborough General Hospital, Woodlands Drive, Scarborough, Yorkshire, UK. jesucachuco@yahoo.com
authors.forename: Jesus V
authors.initials: JV
authors.lastname: Barandiaran
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Hall
authors.forename: Michael
authors.initials: M
authors.lastname: Lim
authors.forename: N
authors.initials: N
authors.lastname: El-Barghouti
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Perry
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000772:Anesthesia, Local; D004739:England; D005260:Female; D005268:Femoral Vein / Q000601:surgery*; D006801:Humans; D008026:Ligation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012008:Recurrence; D012501:Saphenous Vein / Q000601:surgery*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014648:Varicose Veins / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects