Clinical Outcomes of Surgical Procedures for Primary Varicose Veins of Great Saphenous Trunk

Abstract

We evaluated the surgical outcomes and postoperative venous functions achieved with each of our surgical procedures for primary varicose veins of great saphenous trunk. Thigh stripping combined with saphenous trunk foam sclerotherapy, endovenous laser ablation with 980-nm diode laser combined with saphenous trunk foam sclerotherapy and subfascial endoscopic perforating vein surgery combined with stripping achieved good surgical outcomes. Postoperative venous function by air plethysmography showed significant improvement with all surgical procedures. In our surgical experience with primary varicose veins of great saphenous trunk, endovenous laser ablation combined with saphenous trunk foam sclerotherapy should be performed if the average diameter of the saphenous vein with valvular insufficiency is less than 10 mm and thigh stripping combined with saphenous trunk foam sclerotherapy should be performed if the average diameter exceeds 10 mm in C2-C4a cases of the CEAP classification. In C4b-C6 cases of the CEAP classification, subfascial endoscopic perforating vein surgery combined with stripping should be performed. Based on good surgical outcomes and improvement of postoperative venous functions with all surgical procedures, we conclude that our surgical strategy for primary varicose veins of saphenous trunk is adequate.

Positioning for Endovenous Laser Ablation: Comparative Study with Thigh Stripping

“…7,10,13) Spontaneous disappearance of EHIT with only follow-up of the course was reported in Class 1 and 2 cases and after anti-coagulation therapy in Class 3 cases. 7,10) The two Class 3 legs we encountered showed spontaneous disappearance after compression therapy combined with warfarin administration for 3 or 6 months.…”

“…The incidence of EHIT was reported to be 1.5%-15%, 7,10,13) but Class 3 was observed only in 0.3%-1.6%, and no Class 4 case was reported. 7,10,13) Spontaneous disappearance of EHIT with only follow-up of the course was reported in Class 1 and 2 cases and after anti-coagulation therapy in Class 3 cases.…”

“…Bruising occurred in 41.1% of the legs, but improved in each leg 1 month after the operation. As other complications, transient sensory disturbance (paresthesia) was reported to be 0.8%-17.3%, 10,12,13,15) thrombophlebitis in 0.3%-5.5%, 7,15) hematoma formation in 0.8%-7.5%, 10,13) and induration in 26.9%-33.8%. 7,15) Serious complications such as deep venous thrombosis pulmonary embolism, skin burns, and arteriovenous fistulas were reported extremely rarely, and were also absent in our study.…”

“…The procedures of both stripping and EVLA were previously reported. [5][6][7] Trunk foam sclerotherapy for the lower leg was performed simultaneously with each surgical technique during the operation. As EVLA, GSV ablation was performed from 15 mm distal to the sapheno-femoral function (SFJ) or just distal to the superficial epigastric vein at a linear endovenous energy density (LEED) of 80.9 ± 3.7 J/cm.…”

“…In October 2011, we also introduced EVLA, and have performed this procedure as the first choice for saphenous type varicose veins and obtained favorable short-term results. 7) We compared treatment results and pre-and postoperative venous functions between EVLA and stripping, and evaluated the possibility that EVLA is comparable to stripping or even can replace it with a review of the literature.…”