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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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

lingua: Inglese

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


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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