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A Journal on Phlebology
Acta Phlebologica 2009 April;10(1):5-10
Selective vs radical crossectomy of the great saphenous vein in primitive venous insufficiency: results at 5 years
Mariani F., Bucalossi M., Mancini S., Mancini S.
Department of General Surgery, Siena University, Siena, Italy The Compression Therapy study Group (CTG) Colle Val d’Elsa, Siena, Italy
Aim. The aim of the study is to keep again the incidence of groin recurrences at 5 years follow-up, on two groups of patients operated with a technique of selective crossectomy and radical crossectomy of the great saphenous vein (GSV), to verify the importance of the collateral veins of S-F junction in groin recurrences. The classic surgery of superficial venous system has had many improvements, so the “traditional” idea of radical crossectomy (Babcock, 1907) has been won by the “new” selective technique, which may be executed on traditional way or by the new endovascular techniques.
Methods. Non-concurrent prospective study, the selected casuistry concerns in 300 patients (220 female and 80 male, mean age 54 years, range 25-77), CEAP 2-S/3 Ep As(2/3) Pr, operated from January 2002 to December 2006, choosed with random method, divided in two groups (150 treated by selective crossectomy and 150 by radical crossectomy), 60 patients for every year was considered. All the patients were operated of crossectomy by an unique surgeon for each group, in day-surgery and local anesthesia. All these patients were submitted to clinical venous examination and to Duplex scanning of the lower limbs, by an independent operator, at different times from the operation (the follow-up is from 5 years for the patients operated in 2002 to 1 years for the patients operated in 2006).
Results. On 300 patients controlled with Duplex has been seen in the group of selective crossectomy 1 groin recurrence (0.6%), in the group of radical crossectomy 14 groin recurrences (9.3%).
Conclusion. Based on the clinic experience done on examined 300 patients, we can observe like the internal selective crossectomy, saving the tributary veins coming from the abdominal wall, joint to the convenient treatment of saphenous insufficiency, revealed an efficacious therapy, giving results of undoubtable validity from the point of view prognostic and the rate of groin recurrences at 5 years.