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The Journal of Cardiovascular Surgery 1998 April;39(2):151-62

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Saphenous vein sparing surgery: principles, techniques and results

Zamboni P., Marcellino M. G., Cappelli M., Feo C. V., Bresadola V., Vasquez G., Liboni A.

From the Institute of General Surgery and Vascular Laboratory University of Ferrara, Ferrara, Italy


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Objective. Evaluation of saph­e­nous ­vein spar­ing sur­gi­cal pro­ce­dures alter­na­tive to ­high liga­tion ­and dis­tal ­stab avul­sion, in ­terms of effec­tive­ness ­and suit­abil­ity ­for even­tu­al ­bypass sur­gery.
Experimental ­design. Prospective eval­u­a­tion of 421 oper­a­tions ­for pri­mary var­i­cose ­veins, 64 exter­nal ­valve-plas­ties of ­the saphe­no-femo­ral junc­tion (EV-­SFJ), (42 per­formed ­using ­the ­hand sew­ing tech­nique ­and 22 ­using ­the Veno-­cuff ­device), ­mean fol­low-up 52 ­months, ­and 357 hemo­dy­nam­ic cor­rec­tion of var­i­cose ­veins (French acro­nymis CHI­VA), ­mean fol­low-up 49 ­months. Moreover, a sub­group of 27 ­patients ­was oper­at­ed on ­using ­the CHI­VA tech­nique in ­two ­steps, ­mean fol­low-up 18 ­months.
Setting. Institute of General Surgery, University of Ferrara. Institutional prac­tice, ­one-­day sur­gery.
Patients. Patients ­were select­ed ­using clin­i­cal ­and ­duplex scan­ning eval­u­a­tions, ­and clas­si­fied accord­ing to ­CEAP cri­te­ria. Patients ­with var­i­cose ­veins ­due to saphe­no-femo­ral ­reflux ­with ­duplex scan­ning evi­dence of ­mobile ­valve leaf­lets under­went EV-­SFJ. The oth­er ­patients ­were oper­at­ed on ­using ­the hemo­dy­nam­ic cor­rec­tion tech­nique.
Interventions. EV-­SFJ ­restores ­valve func­tion cor­rect­ing ­vein ­wall dil­a­ta­tion by apply­ing an exter­nal pros­the­sis. CHI­VA con­sists of sel­e­ct­ed lig­a­tures of ­the super­fi­cial ­veins ­that ­allow super­fi­cial ­blood aspi­ra­tion in ­the ­deep ­veins ­through ­the per­fo­ra­tors as ­well as ­the pres­er­va­tion of saph­e­nous drain­age.
Measures. The out­come ­was eval­u­at­ed ­with inde­pen­dent clin­i­cal ­and ultra­son­o­graph­ic exam­ina­tions; ­pre ­and post­op­er­a­tive ­AVP ­and ­LRR-RT meas­ure­ments ­were ­assessed in 125 cas­es. Data ­from ­self-assess­ment of ­the func­tion­al ­and cos­met­ic ­result of ­the ­patients of ­the CHI­VA ­group ­were ­also ­obtained ­using a scor­ing ­system. Moreover, scan­ning ­the pre­served ­long saph­e­nous ­vein ­the ­rate of ­long saph­e­nous ­vein suit­able as arte­ri­al con­duit fol­low­ing spar­ing sur­gery ­was ­also eval­u­at­ed.
Results. Overall ­long saph­e­nous ­vein paten­cy reg­is­tered ­after EV-­SFJ ­and CHI­VA ­was 94%. Varicose ­veins recur­rence ­rate ­was 12% ­and 11 %, respec­tive­ly. Postoperative ­AVP ­and ­LRR-RT improve­ment ­was stas­ti­cal­ly sig­nif­i­cant (p<0.001).
Conclusions. These ­two alter­na­tive pro­ce­dures ­seem to be effec­tive in varic­es treat­ment fol­low­ing ­the pro­posed indi­ca­tions ­and tech­niques. In addi­tion, ­they ­appear ­able to pre­serve a ­more sig­nif­i­cant ­rate of saph­e­nous ­veins suit­able ­for even­tu­al ­bypass sur­gery ­than ­high liga­tion ­and mul­ti­ple cos­met­ic avul­sion.

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