Changes in venous hemodynamics after superficial vein surgery for mixed superficial and deep venous insufficiency

The purpose of this study was to determine the hemodynamic changes after su perficial vein surgery in patients with mixed superficial and deep venous i nsufficiency (MVI). Between July 1996 and June 1998, all patients with MVI together with saphenofemoral reflux were evaluated prospectively with air p lethysmography (APG) and duplex scanning be fore and 1 month after superfic ial vein surgery. Saphenofemoral flush ligation without stripping was perfo rmed with multiple small incisions for avulsion of varicosities. Seventy-ei ght patients with 102 operated limbs were included for analysis. The venous filling index (VFI), ejection fraction (EF), and residual volume fraction (RVF) improved significantly after superficial vein surgery (mean VFI 5.99 +/- 3.39 vs. 1.82 +/- 1.21 ml/s, p < 0.001; mean EF 48.39% <plus/minus> 11. 74% vs. 52.78% +/- 14.33%, p < 0.05; mean RVF 49.80% <plus/minus> 11.18% vs . 36.19% +/- 12.98%, p < 0.001, respectively, before and after operation). The proportion of limbs with deep venous incompetence on duplex scanning at more than one site decreased from 70% to 44% after operation. The mean num ber of sites with deep venous incompetence decreased from 2.14 <plus/minus> 0.96 to 1.52 +/- 1.21 after operation (p < 0.001). In conclusion, superfic ial vein surgery resulted in significant improvement in hemodynamic paramet ers in limbs with MVI. There was also abolition of deep venous reflux after superficial vein surgery alone. Superficial vein surgery should be the fir st line of treatment in limbs with MVI, with deep vein reconstructive surge ry reserved for those not responding to superficial vein surgery.