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Resecting the great saphenous stump with endothelial inversion decreases neither neovascularization nor thigh varicosity recurrence.
J Vasc Surg. 2008 May; 47(5):1028-32.JV

Abstract

BACKGROUND

Neovascularization at the saphenofemoral junction is one of the principal causes of recurrent varicose veins after great saphenous vein surgery. Because angiogenic stimulation from the exposed endothelium of the great saphenous vein stump is considered an important trigger for this process, we hypothesized that complete resection of the stump with endothelial inversion might lessen grade 2 groin neovascularization and thereby decrease recurrence of thigh varicosities.

METHODS

Two groups of consecutive patients with primary varicose veins of the great saphenous vein were studied. Group A was a historical control group of 70 limbs (48 patients) in which conventional flush ligation was performed at the level of the saphenofemoral junction. Group B was a prospectively studied clinical trial cohort of 65 limbs (45 patients), wherein the great saphenous vein stump was completely resected using a side-biting clamp to isolate the saphenofemoral junction, and the resulting common femoral vein venotomy was closed with a running inverting suture. Early postoperative follow-up was performed at 6 weeks. Clinical examinations and duplex ultrasound scans were performed after 2 years of follow-up. Grade 2 groin neovascularization was defined by the presence of >3 mm tortuous new refluxing veins, typically communicating with recurrent varicosities in the thigh.

RESULTS

After 2 years, recurrent varicose veins were present in the thighs of 13 of 65 limbs (20%) in group A and in 22 of 61 limbs (36%) of group B (P = .049). Grade 2 neovascularization was present at the saphenofemoral junction in six of 65 limbs (9%) of group A and in 12 of 61 limbs (20%) of group B (P = .127).

CONCLUSION

Complete resection of the great saphenous vein stump and inversion suturing of the common femoral vein venotomy, instead of simple flush ligation at the level of the saphenofemoral junction, do not appear to decrease grade 2 neovascularization and related thigh varicosity recurrence after great saphenous vein stripping for primary varicose veins.

Authors+Show Affiliations

Department of Surgery, District Hospital of Frutigen, Frutigen, Switzerland. dominik.heim@spitalfmi.chNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

18358671

Citation

Heim, Dominik, et al. "Resecting the Great Saphenous Stump With Endothelial Inversion Decreases Neither Neovascularization nor Thigh Varicosity Recurrence." Journal of Vascular Surgery, vol. 47, no. 5, 2008, pp. 1028-32.
Heim D, Negri M, Schlegel U, et al. Resecting the great saphenous stump with endothelial inversion decreases neither neovascularization nor thigh varicosity recurrence. J Vasc Surg. 2008;47(5):1028-32.
Heim, D., Negri, M., Schlegel, U., & De Maeseneer, M. (2008). Resecting the great saphenous stump with endothelial inversion decreases neither neovascularization nor thigh varicosity recurrence. Journal of Vascular Surgery, 47(5), 1028-32. https://doi.org/10.1016/j.jvs.2007.12.039
Heim D, et al. Resecting the Great Saphenous Stump With Endothelial Inversion Decreases Neither Neovascularization nor Thigh Varicosity Recurrence. J Vasc Surg. 2008;47(5):1028-32. PubMed PMID: 18358671.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Resecting the great saphenous stump with endothelial inversion decreases neither neovascularization nor thigh varicosity recurrence. AU - Heim,Dominik, AU - Negri,Marco, AU - Schlegel,Urs, AU - De Maeseneer,Marianne, Y1 - 2008/03/21/ PY - 2007/09/26/received PY - 2007/12/11/revised PY - 2007/12/16/accepted PY - 2008/3/25/pubmed PY - 2008/6/13/medline PY - 2008/3/25/entrez SP - 1028 EP - 32 JF - Journal of vascular surgery JO - J Vasc Surg VL - 47 IS - 5 N2 - BACKGROUND: Neovascularization at the saphenofemoral junction is one of the principal causes of recurrent varicose veins after great saphenous vein surgery. Because angiogenic stimulation from the exposed endothelium of the great saphenous vein stump is considered an important trigger for this process, we hypothesized that complete resection of the stump with endothelial inversion might lessen grade 2 groin neovascularization and thereby decrease recurrence of thigh varicosities. METHODS: Two groups of consecutive patients with primary varicose veins of the great saphenous vein were studied. Group A was a historical control group of 70 limbs (48 patients) in which conventional flush ligation was performed at the level of the saphenofemoral junction. Group B was a prospectively studied clinical trial cohort of 65 limbs (45 patients), wherein the great saphenous vein stump was completely resected using a side-biting clamp to isolate the saphenofemoral junction, and the resulting common femoral vein venotomy was closed with a running inverting suture. Early postoperative follow-up was performed at 6 weeks. Clinical examinations and duplex ultrasound scans were performed after 2 years of follow-up. Grade 2 groin neovascularization was defined by the presence of >3 mm tortuous new refluxing veins, typically communicating with recurrent varicosities in the thigh. RESULTS: After 2 years, recurrent varicose veins were present in the thighs of 13 of 65 limbs (20%) in group A and in 22 of 61 limbs (36%) of group B (P = .049). Grade 2 neovascularization was present at the saphenofemoral junction in six of 65 limbs (9%) of group A and in 12 of 61 limbs (20%) of group B (P = .127). CONCLUSION: Complete resection of the great saphenous vein stump and inversion suturing of the common femoral vein venotomy, instead of simple flush ligation at the level of the saphenofemoral junction, do not appear to decrease grade 2 neovascularization and related thigh varicosity recurrence after great saphenous vein stripping for primary varicose veins. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/18358671/Resecting_the_great_saphenous_stump_with_endothelial_inversion_decreases_neither_neovascularization_nor_thigh_varicosity_recurrence_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(07)02112-X DB - PRIME DP - Unbound Medicine ER -