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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2002 December;21(4):333-6


language: English

Duplex imaging analysis of the long saphenous vein reflux: basis for strategy of endovenous obliteration treatment

Pichot O. 1, Sessa C. 2, Bosson J. L. 3

Divisions of 1 Vascular Medicine, 2 Vascular Surgery, 3 Clinical Investigation Center, Grenoble University Hospital, Grenoble, France


Background. The pur­pose of this study was to char­ac­ter­ize great­er saph­e­nous vein (GSV) ­reflux in order to bet­ter ­define indi­ca­tions for appro­pri­ate endo­vas­cu­lar oblit­er­a­tion treat­ment.
Methods. Color-flow ­duplex imag­ing was used pros­pec­tive­ly to cat­e­go­rize 133 lower limbs of 102 con­sec­u­tive out­pa­tients, pre­sent­ing with chron­ic super­fi­cial vein dis­ease asso­ciat­ed with GSV incom­pe­tence. Sapheno-femo­ral junc­tion (SFJ) and trib­u­tar­ies mor­phol­o­gy and hemo­dy­nam­ics, and GSV main trunk ­reflux ­extent were ­assessed.
Results. GSV ­reflux was relat­ed to ter­mi­nal valve incom­pe­tence in 70 (52.3%) limbs, to sub-ter­mi­nal valve incom­pe­tence in 37 (27.8%), and to seg­men­tal incom­pe­tence of the GSV trunk in 26 (19.6%). Reflux orig­i­nat­ed from com­mon femo­ral vein (CFV) and/or SFJ trib­u­tar­ies and/or GSV col­lat­er­als, includ­ing mul­ti­ple ori­gins com­bi­na­tions. CFV was the ­reflux ori­gin in 77 (57.9%). GSV ­reflux arose from SFJ or trunk trib­u­tar­ies in 69 (51.9%) and 32 (24%), limbs respec­tive­ly. Circumflex and super­fi­cial epi­gas­tric veins were ­involved in 65.2% and 50.7% respec­tive­ly of the SFJ trib­u­tar­ies. GSV ­reflux extend­ed down to the mid-third of the calf or below in only 45 cases (33.7%). The age of the ­patients was not cor­re­lat­ed with ­reflux ori­gin.
Conclusions. Preliminary anal­y­sis sug­gests that in 2/3 of the cases, endo­ve­nous oblit­er­a­tion treat­ment ­should ­extent from the thigh to just below the knee. Furthermore, in order to pre­serve GSV com­pe­tent ­valves and col­lat­er­al veins drain­age, treat­ment ­should start just below the main SFJ trib­u­tary when the ter­mi­nal valve is still com­pe­tent, and just below the main branch­es con­nec­tion when only the GSV trunk is incom­pe­tent.

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