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A Journal on Phlebology
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Acta Phlebologica 2008 December;9(3):105-7
Suppression of the sapheno-femoral reflux by pure non-saphenous phlebectomy and anatomical structure of the reflux
Diagnostic Center “Aquarius”, Naples, Italy
Aim. Recently, several hypotheses on varicose veins origin were proposed. Accordingly, a non-saphenous foam procedure was shown to achieve successful results in the suppression of the sapheno-femoral reflux, being its persistence limited to a small percentage of treated cases. The aim of the present note is to illustrate the hemodynamic basis of these reflux suppressing failures.
Methods. Two hemodynamic theoretic simulations were designed to represent adequately this hemodynamic condition. The sapheno-femoral reflux can be classified according to Teupitz into two kinds of different shunts: ShI and ShIII. The ablation of the varicosity’s of the non-saphenous superficial network can achieve the disconnection of Sh III and VI, but in no way of Sh I. So that, if the main reflux is a ShI the sapheno-femoral reflux does not disappear after the phlebectomy.
Results. The thorough study of the patient’s cartography makes the choice of the surgical strategy easier and more precise.
Conclusion. Depending on the structure of the reflux and as to immediate results, GSV ablation can sometimes solve completely the varicose pathology, while in other cases it is completely unsatisfying.