ALTERNATIVE SAPHENOUS-VEIN SPARING SURGERY FOR FUTURE GRAFTING

Objective. Evaluation of long saphenous vein sparing surgical procedur es alternative to high ligation and distal stab avulsion, in terms of effectiveness and suitability for eventual by-pass surgery. Experiment al design. Prospective evaluation of 125 operations for primary varico se veins, 52 external valve-plasties of the sapheno-femoral junction ( EV-SFJ) (42 performed using the hand sewing technique and 10 using the Veno-cuff device), mean follow-up 45 months, and 73 hemodynamic corre ction of varicose veins (French acronyms: CHIVA), mean follow-up 30 mo nths, Setting. Department of General Surgery, University of Ferrara, I nstitutional practice, one-day surgery. Patients. Patients were select ed using clinical, Doppler cw, and duplex scanning evaluations. Patien ts with early varices due to sapheno-femoral reflux with duplex scanni ng evidence of mobile valve leaflets underwent EV-SFJ, The other patie nts were operated on using the hemodynamic correction technique. Both groups underwent preoperative ambulatory venous pressure (AVP) and lig ht reflection rheography-refilling time (LRR-RT) measurements. Interve ntions. EV-SFJ restores valve function correcting vein wall dilatation by applying an external prosthesis, CHIVA consists of selected ligatu res of the superficial veins that allow superficial blood aspiration i n the deep veins through the perforators. Measures. The outcome was ev aluated with clinical and ultrasonographic examinations, AVP and LRR-R T measurements, Results. Long saphenous vein patency registered after EV-SFJ and CHIVA was 94.2% and 90.4%, respectively. Both treatments pr eserve the drainage function in the saphenous system, Varicose veins r ecurrence percentage rate was 9.6% and 10.9%, respectively, Conclusion s. Following the proposed selection criteria, these two alternative pr ocedures seem to be more effective in varices treatment than high liga tion and have the advantage of preserving saphenous veins suitable for eventual by-pass surgery.