Reflux elimination without any ablation or disconnection of the saphenous vein. A haemodynamic model for venous surgery

Objectives: to investigate the possibility of the haemodynamic suppression of reflux in the greater saphenous vein (GSV) without any high and/or strip ping procedure. Design: prospective study; single group of patients. Materials: forty patients affected by primary chronic venous insufficiency of all clinical classes, with demonstrated duplex incompetence both of the sapheno-femoral junction (SFJ) and the GSV trunk, with the re-entry perfora tor located on a GSV tributary. The re-entry point was defined as the perfo rator, whose finger compression of the superficial vein above its opening e liminates reflux in the GSV. Methods: air-plethysmographic parameters as well as duplex scanning were pe rformed both preoperatively, and 1 and 6 months later, respectively. Operat ion consisted in flush ligation and division from the GSV of the tributary containing the re-entry perforating vein. Results: duplex investigation demonstrated both a forward flow and reflux d isappearance in the GSV in 100% and 85% of the cases after 1 and 6 months, respectively. All air-plethysmographic parameters, with the exception of Ej ection Fraction, improves significantly: Venous Volume changed from 150 +/- 9 ml to 114 +/- 7 ml (p < 0.0001), Venous Filling Index from 4.9 +/- 0.5 m l/s to 2.3 +/- 0.2 ml/s (p < 0.0001), and Residual Volume Fraction from 42 +/- 3 ml to 30 +/- 2 ml (p < 0.0001). Conclusions: this study demonstrates that reflux in the GSV system is suppo rted by a gradient of pressure between the anatomical point of reflux and t he point of re-entry in the deep veins. Disconnection of the flow to the re -entry perforator without high ligation of the sapheno-femoral junction sup presses GSV reflux.