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Abnormal popliteal terminations of short saphenous vein in primary varicose vein
Venous Surgery 14.7
Assessment of Reflux in the Greater Saphenous Vein (GSV) Two Years Following High Ligation R.A. FITRIDGE, H.S. RONEK, R.B. DILLEY and E.F. BERNSTEIN, G.L BENVENISTE, La Jolla, California, USA and Adelaide, Australia The present study was undertaken to assess: (1) The efficacy of saphenofemoral junction (SFJ) ligation plus sclerotherapy in the treatment of patients with duplex scan documented SFJ incompetence; (2) Duplex findings at the site of surgery at least two years post-operatively; (3) Patency and competence of the residual greater saphenous vein. SUBJECTS AND METHODS: All patients who had undergone surgical ligation of the SFJ with sclerotherapy a minimum of two years prior to this study period were contacted to assess the state of the SFJ, the fate of the GSV, and the subjective results of this management of their venous disease. RESULTS: Post-operative duplex studies were performed in 66 limbs of 54 patients who had undergone SFJ ligation. All of these also underwent sclerotherapy. Forty of the patients (74%) were female with a mean age of 48 years (range 26-74 years). The mean period of follow-up from time of surgical ligation was 33.7 months (range 24-19 months). SUBJECTIVE RESULTS: At follow-up, 59 (89%) patients felt that they had obtained excellent or moderate improvement in symptoms and 53 (80%) described a great or moderate improvement in appearance. Competence of the saphenofemoral junction: duplex studies of the SFJ were performed in 66 limbs. Duplex scans demonstrated a closed junction in 43 (65%), significant incompetent collateral at the level of the junction in 22 (33%) and an incompetent junction with persistent saphenous reflux in one case. Patency and competence of the greater saphenous vein: of the 66 limbs which had undergone SFJ ligation, seven were revision procedures in which a previous stripping had been performed. Thus 59 limbs contained a residual GSV which was available for examination. The above-knee GSV was patent in 56 limbs (95%) of which 52 (88%) were incompetent. The below-knee GSV was patent in 53 limbs (90%), of which 52 (88%) were incompetent. CONCLUSIONS: A large group of patients (33%) had developed significant collateral veins at the level of the operative site, which generally communicated with an incompetent GSV. Ninety-five percent of poentia[ GSVs were patent to within 10 cm of the SFJ, of which 88% were incompetent. No correlation was found between clinical outcome and duplex findings of incompetence at either the groin or the GSV.
14.8 Study of the Greater Saphenous Vein in Cases of Deep Venous Thrombosis by Means of Colour-Duplex Ultrasonography B. VOlNOVICand D. SA VIC, Belgrade, Yugoslavia The greater saphenous vein (GSV) with its branches represents an important collateral venous flow in cases of deep venous thrombosis (DVT) of the lower extremities. GSV thrombosis associated with DVT of the lower extremities complicates
CARDIOVASCULAR SURGERY SEPTEMBER 1995
both treatment and prognosis of the disease. We examined deep and superficial veins of the lower extremities in 80 patients with clinical signs of DVT. There were 34 female and 46 male patients and the average age was 47 years. A 3.5 MHz convex-array Colour-Doppler transducer (Ultramark ATL9 HDI C3 40R) and 7.5 MHz linear-array Colour-Doppler transducer (Ultramark ATL9 HDI L10-5 38mm) were used. Image and Doppler characteristics of iliac, femoral, popliteal and GVS were determined. We found 16 (20%) femoral and popliteal thromboses, 15 (18.8%) iliofemoral thromboses, 35 (43.7%) iliofemoral and popliteal thromboses, two (2.5%) iliofemoral, popliteal and inferior vena cava thromboses and in 12 cases (15%) only venous stasis was found. In ten cases (12.5%) of iliofemoral and popliteal thrombosis and in two (2.5%) of iliofemoral thrombosis, GVS thrombosis was also diagnosed. The rate of GVS thrombosis associated with DVT of the lower extremities was 17.6. From the results we have concluded that in most cases of GVS thrombosis associated with DVT, massive iliofemoral and popliteal thromboses have been found. Colour-Duplex ultrasonography is an important and reliable method for assessing both deep and superficial leg vein thromboses. We consider this examination of GSV essential in the treatment and prognosis of DVT.
14.9
Abnormal Popliteal Terminations of Short Saphenous Vein in Primary Varicose Vein S. OHGI, T. MAEDA and T. MORI, Yonago, Japan The purpose of this study is to investigate the frequency and patterns of abnormal popliteal terminations in primary varicose veins associated with short saphenous vein (SSV) incompetence, and to report their surgical results. The subjects were 53 lower limbs in 42 patients. Among them, 21 patients had 23 limbs with abnormal terminations. There were no clinical symptoms in two limbs, heaviness in 30, pigmentation in 18, and stasis ulcer in two. After preoperative examinations by ultrasonography, venous Doppler study, and ascending venography, popliteal terminations of SSV were confirmed at operation. Abnormal termination were classified into four types: type 1 with the SSV termination joining the gastrocnemius vein (GV) (21%), type 2 with the SSV termination joining the bifurcating PV (25%), type 3 with the termination of SSV communicating with GV joining the PV (39%), and type 4 with the termination of abnormal vein joining the proximal PV with or without the SSV termination (14%). The sapheno-popliteal junction (SPJ) was not confirmed in 12%. Eight medial and three lateral branches of the GV were ligated in the types 1 and 3. Four abnormal veins were resected in the type 4. Thrombosis of the GV was complicated in two patients in the early postoperative period. A recurrence of varicose vein occurred in the type 3, where the incompetent GV had not been ligated. In primary varicose veins with SSV incompetence, 44% of lower limbs had abnormal popliteal termination, and 60% of them were type 1 or 3. The GV, in type 1 or 3, should be ligated to reduce the recurrence of varicose veins.
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Assessment of Reflux in the Greater Saphenous Vein (GSV) Two Years Following High Ligation R.A. FITRIDGE, H.S. RONEK, R.B. DILLEY and E.F. BERNSTEIN, G.L BENVENISTE, La Jolla, California, USA and Adelaide, Australia The present study was undertaken to assess: (1) The efficacy of saphenofemoral junction (SFJ) ligation plus sclerotherapy in the treatment of patients with duplex scan documented SFJ incompetence; (2) Duplex findings at the site of surgery at least two years post-operatively; (3) Patency and competence of the residual greater saphenous vein. SUBJECTS AND METHODS: All patients who had undergone surgical ligation of the SFJ with sclerotherapy a minimum of two years prior to this study period were contacted to assess the state of the SFJ, the fate of the GSV, and the subjective results of this management of their venous disease. RESULTS: Post-operative duplex studies were performed in 66 limbs of 54 patients who had undergone SFJ ligation. All of these also underwent sclerotherapy. Forty of the patients (74%) were female with a mean age of 48 years (range 26-74 years). The mean period of follow-up from time of surgical ligation was 33.7 months (range 24-19 months). SUBJECTIVE RESULTS: At follow-up, 59 (89%) patients felt that they had obtained excellent or moderate improvement in symptoms and 53 (80%) described a great or moderate improvement in appearance. Competence of the saphenofemoral junction: duplex studies of the SFJ were performed in 66 limbs. Duplex scans demonstrated a closed junction in 43 (65%), significant incompetent collateral at the level of the junction in 22 (33%) and an incompetent junction with persistent saphenous reflux in one case. Patency and competence of the greater saphenous vein: of the 66 limbs which had undergone SFJ ligation, seven were revision procedures in which a previous stripping had been performed. Thus 59 limbs contained a residual GSV which was available for examination. The above-knee GSV was patent in 56 limbs (95%) of which 52 (88%) were incompetent. The below-knee GSV was patent in 53 limbs (90%), of which 52 (88%) were incompetent. CONCLUSIONS: A large group of patients (33%) had developed significant collateral veins at the level of the operative site, which generally communicated with an incompetent GSV. Ninety-five percent of poentia[ GSVs were patent to within 10 cm of the SFJ, of which 88% were incompetent. No correlation was found between clinical outcome and duplex findings of incompetence at either the groin or the GSV.
14.8 Study of the Greater Saphenous Vein in Cases of Deep Venous Thrombosis by Means of Colour-Duplex Ultrasonography B. VOlNOVICand D. SA VIC, Belgrade, Yugoslavia The greater saphenous vein (GSV) with its branches represents an important collateral venous flow in cases of deep venous thrombosis (DVT) of the lower extremities. GSV thrombosis associated with DVT of the lower extremities complicates
CARDIOVASCULAR SURGERY SEPTEMBER 1995
both treatment and prognosis of the disease. We examined deep and superficial veins of the lower extremities in 80 patients with clinical signs of DVT. There were 34 female and 46 male patients and the average age was 47 years. A 3.5 MHz convex-array Colour-Doppler transducer (Ultramark ATL9 HDI C3 40R) and 7.5 MHz linear-array Colour-Doppler transducer (Ultramark ATL9 HDI L10-5 38mm) were used. Image and Doppler characteristics of iliac, femoral, popliteal and GVS were determined. We found 16 (20%) femoral and popliteal thromboses, 15 (18.8%) iliofemoral thromboses, 35 (43.7%) iliofemoral and popliteal thromboses, two (2.5%) iliofemoral, popliteal and inferior vena cava thromboses and in 12 cases (15%) only venous stasis was found. In ten cases (12.5%) of iliofemoral and popliteal thrombosis and in two (2.5%) of iliofemoral thrombosis, GVS thrombosis was also diagnosed. The rate of GVS thrombosis associated with DVT of the lower extremities was 17.6. From the results we have concluded that in most cases of GVS thrombosis associated with DVT, massive iliofemoral and popliteal thromboses have been found. Colour-Duplex ultrasonography is an important and reliable method for assessing both deep and superficial leg vein thromboses. We consider this examination of GSV essential in the treatment and prognosis of DVT.
14.9
Abnormal Popliteal Terminations of Short Saphenous Vein in Primary Varicose Vein S. OHGI, T. MAEDA and T. MORI, Yonago, Japan The purpose of this study is to investigate the frequency and patterns of abnormal popliteal terminations in primary varicose veins associated with short saphenous vein (SSV) incompetence, and to report their surgical results. The subjects were 53 lower limbs in 42 patients. Among them, 21 patients had 23 limbs with abnormal terminations. There were no clinical symptoms in two limbs, heaviness in 30, pigmentation in 18, and stasis ulcer in two. After preoperative examinations by ultrasonography, venous Doppler study, and ascending venography, popliteal terminations of SSV were confirmed at operation. Abnormal termination were classified into four types: type 1 with the SSV termination joining the gastrocnemius vein (GV) (21%), type 2 with the SSV termination joining the bifurcating PV (25%), type 3 with the termination of SSV communicating with GV joining the PV (39%), and type 4 with the termination of abnormal vein joining the proximal PV with or without the SSV termination (14%). The sapheno-popliteal junction (SPJ) was not confirmed in 12%. Eight medial and three lateral branches of the GV were ligated in the types 1 and 3. Four abnormal veins were resected in the type 4. Thrombosis of the GV was complicated in two patients in the early postoperative period. A recurrence of varicose vein occurred in the type 3, where the incompetent GV had not been ligated. In primary varicose veins with SSV incompetence, 44% of lower limbs had abnormal popliteal termination, and 60% of them were type 1 or 3. The GV, in type 1 or 3, should be ligated to reduce the recurrence of varicose veins.
71