ORIGINAL ARTICLE   

Acta Phlebologica 2022 April;23(1):13-8

DOI: 10.23736/S1593-232X.21.00497-5

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Distal crossectomy: an alternative in treatment of venous ulcer. Description of the technique

Fernando VEGA-RASGADO ¹ ✉, Carlos ARREOLA ², Fernando CONTRERAS CISNEROS ², Lourdes A. VEGA-RASGADO ³

¹ Mexican Institute of Phlebology and Lymphology, Mexico City, Mexico; ² Mexican Institute of Phlebology and Lymphology, León, Mexico; ³ Department of Biochemistry, National School of Biological Sciences I.P.N., Mexico City, Mexico

BACKGROUND: The pathophysiology of venous insufficiency and the venous ulcers include mainly the reflux from the saphenofemoral junction (SFJ) that produce venous distal hypertension. This has been treated with ligation at or near the junction with classical surgery, clips, mini-surgery, laser, radiofrequency, glue, sclerotherapy and other methods. We propose a different method for the control of this reflux by ligating the saphenous after the SFJ in the thigh which we have called: distal crossectomy. It is performed with a mini-surgery method and local anesthesia, in a simple and fast way. In this paper we describe the technique.
METHODS: Patients with venous ulcer and without previous surgery were selected, under tumescent anesthesia previous mark on the skin with ultrasound in the distal third of the thigh, a small incision of 1.5 cm or less was made dissecting and exposing the saphenous with a hook, the proximal end is closed with 00 suture and the distal part 5 cc of 2% polidocanol foam are injected, finally conventional closure and bandage was placed.
RESULTS: In the first eight patients all the ulcer healed in 2 months, in two patients after the surgery there was upper segment thrombosis, in two the reflux disappeared and in four the reflux decrease significantly and the diameter in the upper great saphenous vein. In all the cases the patient recovered fast and without significative disturbances. After one year of follow-up there are no thrombi, and the improvement is total, only one immobile patient had a recurrence of the ulcer and was treated with an electrostimulation system. The thrombosed veins that occur after the surgery turn permeable after a year, only one patient had 5 years of follow-up without any disturbance. The results confirm that Saphenofemoral reflux cause a great pressure in the distal leg by the kinetic energy accumulated along all saphenous vein length, the closing of this vein in the thigh avoid the distal hypertension, diverting the downward flow from the SFJ through the perforators veins of the thigh into the deep circulation.
CONCLUSIONS: This report provides information on the pathophysiology of saphenous reflux in the thigh and how it come back to the deep system through the perforators after the closure of the Saphenous vein in the thigh and how distal crossectomy could be a good alternative in the management of venous ulcers, since it is a simple procedure with local anesthesia and minimally invasive surgery.

KEY WORDS: Saphenous vein; Vascular surgical procedures; Femoral vein; varicose ulcer