Alternative saphenous vein sparing surgery for future grafting

Area of Science:

• Vascular Surgery
• Phlebology
• Minimally Invasive Procedures

Background:

• Traditional varicose vein treatments like high ligation and avulsion can compromise saphenous vein viability.
• Preserving the long saphenous vein is crucial for potential future coronary or peripheral artery bypass grafting.
• Alternative surgical approaches aim to treat varicose veins while maintaining saphenous vein function and integrity.

Purpose of the Study:

• To evaluate the effectiveness and suitability of two vein-sparing surgical procedures as alternatives to conventional varicose vein treatments.
• To assess the long-term patency and recurrence rates of external valve-plasties of the sapheno-femoral junction (EV-SFJ) and hemodynamic correction of varicose veins (CHIVA).
• To determine if these procedures preserve the saphenous vein for potential future bypass surgery.

Main Methods:

• Prospective study of 125 patients with primary varicose veins.
• 52 patients underwent EV-SFJ (hand-sewn or Veno-cuff device), and 73 patients underwent CHIVA.
• Preoperative and postoperative assessments included clinical examination, duplex ultrasonography, ambulatory venous pressure (AVP), and light reflection rheography-refilling time (LRR-RT).

Main Results:

• Long saphenous vein patency rates were 94.2% for EV-SFJ and 90.4% for CHIVA after a mean follow-up of 45 and 30 months, respectively.
• Both EV-SFJ and CHIVA preserved the saphenous vein's drainage function.
• Varicose vein recurrence rates were comparable: 9.6% for EV-SFJ and 10.9% for CHIVA.

Conclusions:

• EV-SFJ and CHIVA are effective alternatives to high ligation and avulsion for treating varicose veins.
• These vein-sparing techniques maintain saphenous vein patency and function.
• The preserved saphenous veins remain suitable for potential future bypass surgery, offering a significant advantage over conventional methods.