aree scientifiche

Journal des Maladies Vasculaires, 01 Jan 1991, 16(2):171-178

Abstract 

It is unwise to treat patients with varicose veins without thinking about the possibility of atherosclerotic disease occurring later on. The various procedures of stripping, as well as cryosurgery and sclerosis injections in the saphenous veins destroy veins which are at present the best material for femoro-tibial, femoro-popliteal and coronary bypass. Every year, a great deal of limb salvages cannot be achieved because saphenous veins have been previously removed. As arterial disease occurs one or several decades after the venous complaint, every patient with varicose problems may be concerned. Further more, contrary to a frequent opinion, great saphenous veins of varicose patients are often suitable for arterial bypass. As Doppler combined to duplex scan allow to draw a precise map of the superficial venous channels with their endings, amount of flow back, and caliber of the saphenous veins, it is now possible to propose to most patients conservative procedures: ambulatory phlebectomy or sclerosis injections of peripheral veins in case of minor reflux, crossectomy or CHIVA (Ambulatory Hemodynamic Cure of Venous Insufficiency) in case of major reflux, or association of the various technics. Thus, destructing treatments of saphenous veins should be only proposed to patients whose veins are obviously unsuitable for arterial bypass.

LOUIS FLIGELSTONE, Grace Carolan, MA,

Neil Pugh, Minst P, Muned Shandall, Ian Lane: An assessment of the long potential use as a vascular varicose vein surgery saphenous vein conduit after

J Vasc Surg 1993;18:836-40.

ABSTRAC

Purpose: There is controversy in the surgical management of varicose veins between stripping of the long saphenous vein (LSV) and high ligation. Moreover, preservation of the LSV is desirable for future coronary or peripheral artery bypass. We have studied 75 limbs in 44 patients after high saphenous figation with multiple stab

phlebectomy.

Methods: Subjective assessment of the outcome of surgery was made with a linear analog scale, and objective cosmetic outcome was assessed by an independent observer (IF) who had not been involved in the surgical treatment of these patients with our

modification from the criteria first described by Jakobsen. Patency, length, and diameter of the LSV was measured 6 to 14 months (mean 12 months) after operation with a duplex scanner and a color-flow scanner. Valvular incompetence in the LSV and perforators was also assessed.

Results: Results show a good subjective and objective outcome in 95% and 97% of limbs, respectively. The LSVs were patent from ankle to groin in 68% and from ankle to knee in 82%, with a mean diameter of 4.0 ± 0.1 nun (mean ± SEM). There was no statistically significant difference in symptomatic outcome and presence of reflux in the LSV (X 2 = 0,465; p = 0.4954; NS) or objective cosmetic outcome and the presence of reflux in the LSV (X 2 = 2.916; p = 0.0877; NS).

Conclusions: It is concluded that high saphenofemoral ligation combined with multiple “stab avulsions” preserves an LSV with characteristics suggesting suitability for future use as a vascular prosthesis with good early symptomatic and cosmetic results.

MIKATI A.:Personal experience of GSV conservation for 10 years

Phlébologie 2002, 55, N °2 pag 190

Summary

In 1991 91 patients underwent to GSV sparing surgery after cartographic analysis

In 29 patients non-draining system was performed, In all the others, the saphenous trunk was drained.

Frome the SFJ to ankle diameters compared before surgery and after surgery at 10 follow-up were measured.

The conservation of the saphenous trunk was believed to be a success:

1) when the post-operative dimensions were between 3.5 and 8 mm.

2) when the useful length was equal to or greater than 40 cm

3) when there were no dysplasias.

In the non-draining system the conservation of the total saphenous vein was reached in 68% (CI 50-85%)

In the draining ones in 75% (CI 62-84%).

2 PATIENTS AT 6 AND 8 YEARS OF F-UP ARTERIOPATHY HAVE BEEN TREATED WITH A FEMORO-DISTAL SCAFFOLDING USING THE SAFENA PRESERVED.

2 patients at 6y and 8y of F-up, because of PAD underwent to a femoro-distal by-pass using the preserved saphenous trunk.

JOSEPH D. Cohn, MD, FACS, and Keith F. Korver, MD, FACS: Selection of Saphenous Vein Conduit in Varicose Vein Disease

Ann Thorac Surg 2006;81:1269 –74

Background. Limbs with varicose veins are difficult to assess as a source of saphenous vein conduit. Anatomic, histologic, and ultrasound studies demonstrate two types of longitudinal veins in the lower extremities. The great saphenous vein is deep to the saphenous fascia. Accessory saphenous veins are superficial to this layer and have thin walls with diminished muscle cells and elastic

fiber. Accessory saphenous veins dilate and form varicosities.

Segments of great saphenous veins are often suitable as coronary conduits. No studies have assessed the suitability of saphenous veins as coronary artery conduits in patients with varicose vein disease.

Methods. Intraoperative high-resolution ultrasound studies were performed in coronary artery bypass graft procedures to assess lower extremity venous morphology in limbs of 77 patients without known venous disease, in 19 limbs with venous telangiectases, and in 23 limbs with varicose veins.

Results. Dilated great saphenous vein segments were identified in 6% of normal limb venous segments compared with 21% of segments in limbs with telangiectases (p _ 0.027) and 22% of segments in limbs with varicosities (p _ 0.012). The incidence of absent or hypoplastic great saphenous vein segments is increased in limbs with varicosities (35%) compared with normal limbs (21%; p _

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