Long‐term results of vein sparing varicose vein surgery

• Published in: World journal of surgery 2002-12, Vol.26 (12), p.1507-1511
• Main Authors: Raivio, Peter, Perhoniemi, Vesa, Lehtola, Aarno
• Format: Article
• Language: English
• Subjects: Adult; Aged; Ambulatory Surgical Procedures; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Chronic Venous Disease; Cohort Studies; Color Duplex Ultrasound; Compression Stocking; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures - methods; Phlebography - methods; Recurrence; Reoperation; Risk Assessment; Risk Factors; Sensitivity and Specificity; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Ultrasonography, Doppler - methods; Varicose Vein; Varicose Veins - diagnosis; Varicose Veins - surgery; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - methods; Venous Reflux
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-002-6375-8

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. Résumé Le but de cette étude a été d’évaluer l’évolution fonctionnelle à long terme de la chirurgie conservatrice pour varices des membres inférieurs en utilisant un appareil écho doppler (ED) tenu à la main. Notre série a consisté en 171 patients consécutifs traités en ambulatoire pour varices des membres inférieurs non compliquées. Tout segment de veine considéré comme compétant a été épargné, basé sur les données de l’examen clinique et l’ED, qui a été réalisée en préopératoire lorsque le chirurgien l’a estimé nécessaire. Après un suivi moyen de huit ans, tous les patients ont été examinés, une évaluation systématique par ED a été réalisée et les résultats ont été classés selon la classification «CEAP» et la classification de handicap physique. Pendant le suivi, une réopération a été effectuée ou programmée pour 17% des jambes. Au suivi, 79% de tous les patients étaient asympt