SAPHENECTOMY IN THE PRESENCE OF CHRONIC VENOUS OBSTRUCTION

Background. The results of saphenectomy in patients with morphologic a nd functional obstruction were compared with those in patients without obstruction. Excision of secondary saphenous varices associated with deep venous obstruction has long been considered contraindicated for f ear of compromising its collateral contribution. Recent advances in ac curate functional assessment of venous obstruction maize it possible t o test this concept. Methods. Saphenectomy was carried out in 51 limbs without morphologic or functional obstruction and 64 limbs with varyi ng grades of venous obstruction. Significant deep venous obstruction o n ascending venography was present in the latter group. Functional ass essment of obstruction was based on the arm/foot venous pressure diffe rential technique, outflow fraction measurements, and outflow resistan ce calculations. Valve reconstruction was carried out in conjunction w ith saphenectomy in 81% Of Cases. Results. Saphenectomy was clinically well tolerated in both groups, and there was no difference in outcome as measured by objective tests for obstruction; improvement in reflux and calf venous pump function was largely similar Among seven limbs w ith severe preoperative venous obstruction (grade III or IV), five (70 %) had significantly improved obstructive grading, presumably as a res ult of elimination of reflux flow. Conclusions. The traditional admoni tion against removal of secondary varices should be reexamined. Saphen ectomy may be indicated in postthrombotic syndrome with mixed obstruct ion/reflux. The procedure is clinically well tolerated and without mal sequelae. Improvement in reflux parameters without significant worseni ng of objective measures of obstruction is documented in this group.