SAPHENOUS-VEIN SPARING SURGERY - PRINCIPLES, TECHNIQUES AND RESULTS

Objective. Evaluation of saphenous vein sparing surgical procedures al ternative to high ligation and distal stab avulsion, in terms of effec tiveness and suitability for eventual bypass surgery. Experimental des ign. Prospective evaluation of 421 operations for primary varicose vei ns, 64 external valve-plasties of the sapheno-femoral junction (EV-SFJ ), (42 performed using the hand sewing technique and 22 using the Veno -cuff device), mean follow-up 52 months, and 357 hemodynamic correctio n of varicose veins (French acronymis CHIVA), mean followup 49 months. Moreover, a subgroup of 27 patients was operated on using the CHIVA t echnique in two steps, mean follow-up 18 months. Setting. Institute of General Surgery, University of Ferrara. Institutional practice, one-d ay surgery. Patients. Patients were selected using clinical and duplex scanning evaluations, and classified according to CEAP criteria. Pati ents with varicose veins due to sapheno-femoral reflux with duplex sca nning evidence of mobile valve leaflets underwent EV-SFJ. The other pa tients were operated on using the hemodynamic correction technique. In terventions. EV-SFJ restores valve function correcting vein wall. dila tation by applying an external prosthesis. CHIVA consists of selected ligatures of the superficial veins that allow superficial blood aspira tion in the deep veins through the perforators as well as the preserva tion of saphenous drainage. Measures. The outcome was evaluated with i ndependent clinical and ultrasonographic examinations; pre and postope rative AVP and LRR-RT measurements were assessed in 125 cases. Data fr om self-assessment of the functional and cosmetic result of the patien ts of the CHIVA group were also obtained using a scoring system. Moreo ver, scanning the preserved long saphenous vein the rate of long saphe nous vein suitable as arterial conduit following sparing surgery was a lso evaluated. Results. Overall long saphenous vein patency registered after EV-SFJ and CHIVA was 94%. Varicose veins recurrence rate was 12 % and 11%, respectively. Postoperative AVP and LRR-RT improvement was stastically significant (p<0.001). Conclusions. These two alternative procedures seem to be effective in varices treatment following the pro posed indications and techniques. In addition, they appear able to pre serve a more significant rate of saphenous veins suitable for eventual bypass surgery than high ligation and multiple cosmetic avulsion.