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Long-term results of vein sparing varicose vein surgery
Peter Raivio1, Vesa Perhoniemi, Aarno Lehtola
1Department of Vascular Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, Haartmaninkatu, FIN-00029 Helsinki, Finland. peter.ravio@hus.fi
Insights
Handheld Doppler ultrasound (HHD) aids long-term varicose vein surgery assessment. Thorough preoperative HHD is crucial to identify reflux sites missed during surgery, improving patient outcomes.
Area of Science:
- Vascular Surgery
- Medical Ultrasound
- Phlebology
Background:
- Varicose vein surgery aims for long-term functional outcomes.
- Vein sparing techniques are employed, guided by clinical assessment and handheld Doppler ultrasound (HHD).
- Assessing the long-term efficacy of these techniques is essential.
Purpose of the Study:
- To evaluate the long-term functional results of vein sparing varicose vein surgery.
- To assess the role of handheld Doppler ultrasound (HHD) in identifying recurrence and guiding reoperation.
- To determine the prevalence and location of venous reflux in recurrent varicose veins.
Main Methods:
- A cohort of 171 patients undergoing day-case surgery for uncomplicated lower limb varicose veins were followed.
- Preoperative HHD was used selectively; systematic HHD was performed at a mean 8-year follow-up.
- Patients were assessed using CEAP classification and disability scoring.
Main Results:
- At mean 8-year follow-up, 79% of patients were asymptomatic without reoperation.
- Recurrent varicosities with venous reflux were found in 24% of patients.
- Recurrence was more common when the saphenofemoral junction was not initially addressed; reflux was frequently identified in the long saphenous vein.
Conclusions:
- Handheld Doppler ultrasound (HHD) is effective in detecting reflux sites missed during prior surgery.
- Comprehensive preoperative HHD assessment and marking of reflux pathways are necessary for optimal surgical planning.
- Vein sparing surgery requires careful long-term follow-up and precise identification of reflux sources.
Abstract:
The aim of this study was to assess the long-term functional outcome of vein sparing varicose vein surgery using handheld Doppler ultrasound (HHD). The series consisted of 171 consecutive day-case surgery patients operated on for uncomplicated lower limb varicose veins. Venous segments considered competent were spared based on clinical examination and HHD, which was performed preoperatively only when deemed necessary by the surgeon. After a mean follow-up of 8 years all patients were examined, a systematic HHD evaluation was performed, and the findings were classified according to the CEAP (Clinical, Etiological, Anatomical, Pathophysiological) classification, and disability scoring was performed. During the follow-up period 17% of the legs were reoperated or scheduled for reoperation. At follow-up 79% of all patients were asymptomatic without reoperation. In 24%, recurrent varicosities were present and venous reflux was demonstrated by HHD. Recurrence was two times more common when the saphenofemoral junction had originally been left intact. Of all recurrent cases, reflux was demonstrated in the long saphenous vein (LSV) above the knee in 62%, in the LSV below the knee in 7%, in the short saphenous vein (SSV) in 16%, in the posterior arch vein in 38%, and in a thigh perforator in 8%. Of the legs reoperated during the follow-up period 41% presented with venous reflux at the follow-up visit. We conclude that HHD efficiently reveals sites of reflux that have been missed during previous surgery and that a thorough preoperative HHD examination and marking of reflux routes is required.