Partial Versus Total Stripping of the Great Saphenous Vein Evaluated by Strain-Gauge Plethysmography

This study was undertaken in order to assess the necessity of stripping the great saphenous vein totally or partially in the treatment of varicose veins. Thirty-four patients with varicose veins with no previous treatment were allocated to one of the two following treatments: sapheno–femoral ligation and complete stripping from the groin to the ankle with ligature of incompetent perforators and avulsion of visible varicose veins (group I); and partial stripping from the groin to 5 cm below the line of the knee joint and otherwise treated as mentioned above (group II). All patients were examined clinically before and 3 months after surgery to assess their varicose veins and the sensitivity in the saphenous nerve area. They were all investigated by strain-gauge plethysmography, recording venous return-time (RT) and expelled volume (EV). The patients scored their subjective findings on visual analogue scales (VAS) assessing discomfort, swelling and visual appearance. The Plethysmographic results of the two groups showed that RT increased by 25.5 and 22.5 s, respectively, to 53.4 and 63.6 s (median values) (normal RT > 42 s). The increment of the two groups, is significant, but a comparison does not show any significant difference. The EV-values showed nonsignificant changes. Saphenous nerve damage was found in five of 15 patients in group I and in one of 19 in group II, but this difference is not statistically significant ( P < 0.10). The VAS scores showed a significant improvement in both groups, in terms of discomfort and visible appearance, but that they did not differ in these respects. We conclude that partial stripping does not lead to a different outcome from total stripping, and that partial stripping seems to be the preferable treatment of primary varicose veins.

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COMPARATIVE EVALUATION OF THE RESULTS OF SURGICAL TREATMENT OF ACUTE ASCENDING THROMBOPHLEBITIS OF THE GREAT SAPHENOUS VEIN USING THE ENDOVASCULAR HIGH-FREQUENCY WELDING TECHNIQUE AND TRADITIONAL TECHNIQUE

Wiadomości Lekarskie ◽

10.36740/wlek202004103 ◽

2020 ◽

Vol 73 (4) ◽

pp. 638-641

Author(s):

Serhiy I. Savolyuk ◽

Valentyn A. Khodos ◽

Roman A. Herashchenko ◽

Vladyslav S. Horbovets

Keyword(s):

Saphenous Vein ◽

High Frequency ◽

Comparative Evaluation ◽

Great Saphenous Vein ◽

Pain Syndrome ◽

Surgical Operation ◽

Electric Welding ◽

Group I ◽

Group Ii ◽

Welding Technique

The aim of the study was to conduct a comparative evaluation of the effectiveness of surgical treatment of acute ascending thrombophlebitis of the great saphenous vein using the endovascular high-frequency welding technique and traditional phlebectomy. Materials and methods: Two groups were formed in the conducted study. Group I included patients (n=42) with the acute ascending thrombophlebitis of the great saphenous vein, in whom their thrombosed great saphenous vein was removed using the endovascular high-frequency welding technique. As a source of current, an EK300M1 Svarmed electric welding machine (Ukraine) was used. Electric welding of a thrombosed vein segment was carried out using the endovenous electric welding catheter. Group II included patients (n=31) with the acute ascending thrombophlebitis of the great saphenous vein, who underwent the traditional phlebectomy of the thrombosed great saphenous vein according to Babcock’s technique. Results: In group I no patient revealed presence of pain syndrome with significant intensity during the postoperative period. An infiltrate along the coagulated segments of the great saphenous vein, postoperative oedema and paresthesiae were observed in considerably fewer cases from group I versus group II (р=0.0005, р=0.0001, р=0.0018). During their follow-up for more than 12 months, 2 (4.76 %) of 42 patients from group I revealed partial recanalization of the great saphenous vein (р=0.632). In group I the postoperative inpatient period was 1.3±0.1 days. In group II the above period averaged 4.8±0.8 days (p<0.001). Absence of an intense pain syndrome in group I was caused by a gentle effect of high-frequency electric current itself on the venous wall and paravasal structures. A significant reduction of side effects and complications with a shorter stay of patients in hospital versus the traditional phlebectomy was achieved owing to reduction in the extent of injury of the surgical operation itself with the use of endovascular high-frequency welding. Conclusions: The technique of endovascular high-frequency welding in treatment of acute ascending thrombophlebitis of the great saphenous vein makes it possible to reduce the extent of injury of the surgical operation versus the traditional phlebectomy, results in a significant decrease in the number of side effects and complications and shortens the period of the patient’s stay in hospital.

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Great saphenous vein sparing versus stripping in Trendelenburg operation for primary varicose veins: a prospective study

Polish Journal of Surgery ◽

10.5604/01.3001.0014.6219 ◽

2020 ◽

Vol 93 (1) ◽

pp. 34-39

Author(s):

Ashikesh Kundal ◽

Navin Kumar ◽

Deepak Rajput ◽

Udit Chauhan

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Randomized Study ◽

Duplex Ultrasound ◽

Operative Management ◽

Clinical Severity ◽

Below The Knee ◽

Venous Clinical Severity Score ◽

Significant Difference

Objective: The purpose of this study was to compare the outcome of the great saphenous vein (GSV) sparing versus stripping during Trendelenburg operation for varicose veins. Methods: This was a prospective randomized study of primary varicose vein patients who underwent Trendelenburg operation. Data of patients operated on over a period of 16 months was collected, including: below knee GSV diameter by Duplex Ultrasound and revised venous clinical severity score (rVCSS), calculated preoperatively and postoperatively at 2nd, 4th, and 8th week. Results: A total of 36 patients undergoing Trendelenburg operation were included in the study. Nineteen patients underwent GSV sparing while 17 underwent stripping of GSV till just below the knee after juxtafemoral flush ligation of the great saphenous vein. There was a significant decrease in the below-knee GSV diameter (19% after 2 months) and rVCSS (60.8%) in the sparing group. The stripping group also showed an almost similar decrease in below-knee GSV diameter (19.6% after 2 months) and rVCSS (66.3%). However, no significant difference was found between the two groups in terms of change in GSV diameter (P = 0.467) and rVCSS (P = 0.781). Conclusion: Trendelenburg procedure with sparing of GSV can be done routinely for operative management of varicose veins, where surgery is needed.

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Cost-Effective Management of Venous Ulcer

Cardiovascular Journal ◽

10.3329/cardio.v2i2.6629 ◽

1970 ◽

Vol 2 (2) ◽

pp. 136-141

Author(s):

SAN Alam ◽

AHM Bashar ◽

KM Alam ◽

MN Sabah ◽

GMM Hossain ◽

...

Keyword(s):

Saphenous Vein ◽

Ulcer Healing ◽

Great Saphenous Vein ◽

Cost Effective ◽

Venous Ulcer ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Group I ◽

Venous Surgery ◽

Group Ii

Background: Venous disorders are very common. About 20% of the population suffer from varicose veins, 2% have skin changes which may precede venous ulceration. Venous ulcers represent a common and debilitating condition associated with significant financial loss for the patients as well as the society. Treatment options for these patients are costly and time consuming. In this study we tried to find out cost-effective measures for treating this group of patients.Method: To evaluate the effectiveness and safety of superficial and perforating leg venous surgery along with pharmacotherapy 66 patients with chronic venous leg ulcers are prospectively studied. After proper history taking and clinical examination all patients underwent venous duplex ultrasonography. Patients were divided into two groups. Group I (n=30) includes patients undergoing saphenofemoral ligation and stripping of the great saphenous vein (GSV). In group II (n=36) patients underwent saphenofemoral and incompetent leg perforator ligation along with stripping of the GSV. Conservative measures, local ulcer care and pharmacotherapy were common in both groups.Result: Postoperative complications, total hospital stay and ulcer healing were studied. Ulcer healing was earlier in group II. Remarkable complications were similar in both the groups.Conclusion: For effective and economic care of venous leg ulcers, combination of standard surgical procedures including incompetent perforator and saphenofemoral ligation with great saphenous vein stripping and standard physio-pharmacotherapeutic care is essential. This combined modality of treatment is highly effective in early and complete ulcer healing in patients suffering from venous ulcers.Keywords: Venous ulcer: Saphenofemoral ligation: Perforator ligation. DOI: 10.3329/cardio.v2i2.6629Cardiovasc. j. 2010; 2(2) : 136-141

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A Study of the Mechanisms by Which Haemodynamic Function Improves following Long Saphenous Vein-Saving Surgery

Phlebology The Journal of Venous Disease ◽

10.1177/026835559601100307 ◽

1996 ◽

Vol 11 (3) ◽

pp. 102-105 ◽

Cited By ~ 8

Author(s):

J. Hammarsten ◽

P. Bernland ◽

M. Campanello ◽

M. Falkenberg ◽

O. Henrikson ◽

...

Keyword(s):

Physical Examination ◽

Saphenous Vein ◽

Strain Gauge ◽

Venous Return ◽

Varicose Veins ◽

Return Time ◽

Strain Gauge Plethysmography ◽

Long Saphenous Vein ◽

Primary Varicose Veins ◽

Vein Diameter

Objective: To study the mechanisms by which haemodynamic function improves following long saphenous vein-saving surgery. Design: Cohort study. Patients: Twenty patients, 14 women and six men, with primary varicose veins. Interventions: Varicose vein surgery by the long saphenous vein-saving technique. Main outcome measures: Preoperative investigation by physical examination, strain-gauge plethysmography, phlebography and measurements of the long saphenous vein diameter at four different locations using high-resolution, real-time ultrasound. Three months following vein-saving surgery, the patients were reassessed with physical examination, strain-gauge plethysmography and measurements of the long saphenous vein diameter. Results: All patients but one showed excellent or good results following surgery. The preoperative diameter of the long saphenous vein was reduced by 40% at four different levels in the operated legs ( p<0.01). The venous return time of the same legs increased 2.4 times ( p<0.001). The decrease of the long saphenous vein diameter correlated positively with the increase in venous return time (t-50), ( r=0.50, p=0.04). Conclusion: The results suggest that the development of incompetent perforators is an early major event in the formation of primary varicose veins. The results also suggest that the long saphenous vein valvular incompetence in varicose veins is attributable to venous wall dilatation rather than degeneration of the valves. The results support the hypothesis that the improvement in haemodynamic function following long saphenous vein-saving surgery is due, at least partly, to a reduction of the long saphenous vein diameter, which in turn tends to restore valvular competence.

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Impact on venous haemodynamics after treatment of great saphenous vein incompetence using plethysmography and duplex ultrasound

Phlebology The Journal of Venous Disease ◽

10.1177/0268355519898952 ◽

2020 ◽

Vol 35 (7) ◽

pp. 495-504

Author(s):

P Oskar E Nelzén ◽

Johan Skoog ◽

Malin Öster ◽

Helene Zachrisson

Keyword(s):

Quality Of Life ◽

Radiofrequency Ablation ◽

Saphenous Vein ◽

Strain Gauge ◽

Great Saphenous Vein ◽

Duplex Ultrasound ◽

Venous Occlusion ◽

High Ligation ◽

Strain Gauge Plethysmography

Objectives To evaluate postoperative venous haemodynamics and quality of life after treatment of great saphenous vein (GSV) incompetence. Methods Radiofrequency ablation and high ligation and stripping were performed in 62 patients (65 limbs) and 58 (65 limbs), respectively. Phlebectomies were performed in both modalities. Strain-gauge plethysmography on the foot combined with superficial venous occlusion was used to measure refilling time after knee bends. Strain-gauge plethysmography, duplex ultrasound and quality of life were assessed before and one month after treatment. Results Duplex ultrasound displayed successful intervention in all but two limbs. Refilling time increased similar in radiofrequency ablation and high ligation and stripping after treatment ( p < 0.001). Postoperatively, strain-gauge plethysmography detected remaining reflux in 71% of the patients. Multivariate analysis showed that two or more incompetent calf branches were associated with remaining reflux (OR 4.82 (95% CI: 1.33–17.5), p = 0.02). No difference in quality of life was seen in patients with remaining reflux. Conclusions Despite successful treatment, a majority of the limbs showed remaining reflux, in which incompetent calf branches appear to play an important role. Clinicaltials.gov: Lower Limb Venous Insufficiency and the Effect of Radiofrequency Treatment Versus Open Surgery. Nr: NCT02397226

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Crossectomy and Foam Sclerotherapy of the Great Saphenous Vein versus Stripping of Great Saphenous Vein and Varicectomy in the Treatment of the Legs Ulcers

Ulcers ◽

10.1155/2013/734859 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5

Author(s):

Alvaro Delgado-Beltran

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Average Rate ◽

Healing Time ◽

Foam Sclerotherapy ◽

Group I ◽

Incomplete Healing ◽

Invasive Method ◽

Group Ii

Objective. To show our results in the surgical treatment of legs varicose ulcers, with crossectomy and foam sclerotherapy (CAFE) of the great saphenous vein (GSV) in group I and stripping of GSV and varicectomy in group II. Methods. 35 patients with active venous leg ulcers were recruited and treated. They were collected in two groups. Group I were treated by crossectomy and foam sclerotherapy of the GSV and group II were treated by stripping of GSV and varicectomy. The healing time of the ulcer and the complications were recorded after the procedure in the follow-up visits. Results. 29 out of the 35 patients completed the follow-up. There were eight cases of incomplete healing of the leg ulcer, 4 in group I (19.04%) and 4 in group II (40%), P<0.05. The average rate of healing in group I was 0.38 cm/day and 0.13 in group II, P<0.05. Conclusion. CAFE technique of the great saphenous vein in the treatment of 6 CEAP patients is a procedure that improves the rate of ulcer healing as compared to these two groups. It is a safe and reliable minimally invasive method, with less morbidity.

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Saphenous vein stripping surgical technique and frequency of saphenous nerve injury

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514539316 ◽

2014 ◽

Vol 30 (3) ◽

pp. 210-216 ◽

Cited By ~ 1

Author(s):

Aleksandra Jaworucka-Kaczorowska ◽

Grzegorz Oszkinis ◽

Juliusz Huber ◽

Agnieszka Wiertel-Krawczuk ◽

Elżbieta Gabor ◽

...

Keyword(s):

Nerve Injury ◽

Saphenous Vein ◽

Clinical Neurophysiology ◽

Varicose Veins ◽

Group Iv ◽

Saphenous Nerve ◽

Nerve Sparing ◽

Sensory Transmission ◽

Group I ◽

Saphenous Nerve Injury

Objectives Saphenous nerve injury is the most common complication after surgical treatment of varicose veins. The aim of this study was to establish its frequency at great saphenous vein long stripping when four methods of surgery were applied. Methods Eighty patients were divided into four groups depending on different stripping methods. Sensory transmission in saphenous nerve and sensory perception of shank were examined before surgery and two weeks, three and six months afterwards with clinical neurophysiology methods. Results In 36% of patients, surgeries caused the injury of saphenous nerve mainly by proximal stripping without invagination (65%, group I). Transmission disturbances ceased completely after three months in patients undergoing distal stripping with invagination (group IV), while in group I they persisted for six months in 35%. Group IV patients were the least injured and group I the most. Conclusion Neurophysiological findings may suggest that distal stripping with vein invagination gives the best saphenous nerve sparing.

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Great Saphenous Vein Conventional Surgery in Brazil's Outpatients

ISRN Vascular Medicine ◽

10.5402/2011/372450 ◽

2011 ◽

Vol 2011 ◽

pp. 1-2

Author(s):

Charles Angotti Furtado de Medeiros ◽

Ana Terezinha Guillaumon

Keyword(s):

Nerve Injury ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Saphenous Nerve ◽

High Ligation ◽

Outpatient Basis ◽

Clinical Classification ◽

Conventional Surgery ◽

Saphenous Nerve Injury

Objective. Evaluate great saphenous vein conventional surgery performed on an outpatient basis. Methods. Retrospective analysis where patients complain varicose veins with saphenofemoral incompetence and great saphenous vein reflux on Doppler ultrasound. These patients were consecutively enrolled to high ligation plus stripping, either to the ankle or only to the knee, or crossectomy alone. Results. Data from 106 surgery outpatients with CEAP clinical classification is as follows: varicose veins (59.5%), edema (15.1%), skin alterations (9.4%), healed ulcer (9.4%), or open ulcer (6.6%). The techniques employed were 66 high ligations plus stripping to the ankle, 28 high ligations plus stripping to the thigh portion, and 12 crossectomy. No major complications were observed. Overall, 18% reported symptoms consistent with saphenous nerve injury. All but one belonged to the stripping to the ankle group. Conclusion. Great saphenous vein conventional surgery performed on outpatients is very safe. Nerve injury is frequent when stripping extends the ankle.

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Invasive therapeutic options in truncal varicosity of the great saphenous vein

VASA ◽

10.1024/0301-1526.35.3.157 ◽

2006 ◽

Vol 35 (3) ◽

pp. 157-166 ◽

Cited By ~ 7

Author(s):

Hach-Wunderle ◽

Hach

Keyword(s):

Minimally Invasive ◽

Saphenous Vein ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Venous Pressure ◽

Stage Iii ◽

High Ligation ◽

Surgical Trauma ◽

Disease Stages

It is known from current pathophysiology that disease stages I and II of truncal varicosity of the great saphenous vein do not cause changes in venous pressure on dynamic phlebodynamometry. This is possibly also the case for mild cases of the disease in stage III. In pronounced cases of stage III and all cases of stage IV, however, venous hypertension occurs which triggers the symptoms of secondary deep venous insufficiency and all the complications of chronic venous insufficiency. From these facts the therapeutic consequence is inferred that in stages I and II and perhaps also in very mild cases of stage III disease, it is enough "merely" to remove varicose veins without expecting there to be any other serious complications in the patient’s further life caused by the varicosity. Recurrence rates are not included in this analysis. In marked cases of disease stages III and IV of the great saphenous vein, however, secondary deep venous insufficiency is to be expected sooner or later. The classical operation with saphenofemoral high ligation ("crossectomy") and stripping strictly adheres to the recognized pathophysiologic principles. It also takes into account in the greatest detail aspects of minimally invasive surgery and esthetics. In the past few years, developments have been advanced to further minimize surgical trauma and to replace the stripping maneuver using occlusion of the trunk vein which is left in place. Obliteration of the vessel is subsequently performed via transmission of energy through an inserted catheter. This includes the techniques of radiofrequency ablation and endovenous laser treatment. High ligation is not performed as a matter of principle. In a similar way, sclerotherapy using microfoam is minimally invasive in character. All these procedures may be indicated for disease stages I and II, and with reservations also in mild forms of stage III disease. Perhaps high ligation previously constituted overtreatment in some cases. Targeted studies are still needed to prove whether secondary deep venous insufficiency can be avoided in advanced stages of varicose vein disease without high ligation and thus without exclusion of the whole recirculation circuit.

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Impact of hemodialysis on the wellbeing of chronic kidney diseases patients: a pre-post analysis

Middle East Current Psychiatry ◽

10.1186/s43045-020-00060-x ◽

2020 ◽

Vol 27 (1) ◽

Author(s):

Um-e-Kalsoom ◽

Sabiha Khan ◽

Israr Ahmad

Keyword(s):

Quality Of Life ◽

Social Support ◽

Perceived Social Support ◽

Kidney Diseases ◽

Chronic Kidney Diseases ◽

Group I ◽

Significant Difference ◽

Group Ii ◽

The Impact

Abstract Background Hemodialysis may have serious psychological impact upon patients suffering from chronic kidney diseases. The aim of the present study is to investigate the impact of hemodialysis on the wellbeing of individuals with chronic kidney diseases (CKD). Result A sample consists of (N = 100) CKD patients referred from neurology ward of Leady Reading Hospital Peshawar. Data was collected from both male (50%) and female (50%) in 2017. Participants were divided into two groups on the basis of pre-set criteria. In group I, individuals with 4–5 stage of CKD referred first time for dialysis treatment were recruited. Group II comprised of CKD patients with 1–3 stage. Demographic data sheet, Pakistan Anxiety and Depression, WHO Quality of Life scale, and Perceived Social support scale (PSS) were used to test the hypotheses. Paired sample t test was use to see the difference between pre- and post-analysis of depression, anxiety, QOL, and PSS in group I (experimental group). Results suggests significant difference on depression (p > .001), anxiety (p > .001), and QOL (p > .001), while no significant difference was reported on perceived social support (p <.673). Findings also indicate no significant difference between group I and group II on QOL depression, anxiety, and PSS. Conclusion The findings concluded that patients under hemodialysis treatment suffered from depression, anxiety, and poor quality of life.

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