Mini-invasive high-tie by clip apposition versus crossectomy by ligature: Long-term outcomes and review of the available therapeutic options

Gianesini, Sergio; Menegatti, Erica; Malagoni, Anna Maria; Occhionorelli, Savino; Zamboni, Paolo

doi:10.1177/0268355516648066

Cited by 7 publications

(12 citation statements)

References 36 publications

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“…29,30,[33][34][35][36] Pelvic reflux has been demonstrated to be a source of recurrent SFJ leakage in up to 17% of cases, 1 while, particularly in the past, major importance has been attributed to the performance of a correctly performed high tie. 11 Nevertheless, only 11% of recurrences have been associated with lack of surgical experience. 37,38 A novel pathophysiological observation is emerging regarding the association among obstructive/refluxing iliac vein disease and CVD severity.…”

Section: Discussionmentioning

confidence: 99%

“…1,4,5 Much attention has been focused on SFJ surgical treatment technique, stressing the importance of a flush ligation to be performed on the femoral vein with the aim of preventing recurrence. [6][7][8][9][10] Nevertheless, despite a technically perfect flush ligation, 11 the main source of recurrence is found right on the SFJ, leading to the need for a re-do surgery that in turn is reported to fail in 30 to 80% of cases. [12][13][14][15] Clear pathophysiological, diagnostic and therapeutic evidence regarding this topic are still lacking.…”

Section: Introductionmentioning

confidence: 99%

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Femoral vein valve incompetence as a risk factor for junctional recurrence

et al. 2017

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Background Recurrent varicose veins occur up to 80% of procedures. The sapheno-femoral junction can be involved in more than 50% of cases. A detailed pathophysiological explanation of the phenomenon is still missing. The aim of the present work is to evaluate the role of femoral vein incompetence as risk factor for sapheno-femoral junction recurrence. Methods Three-hundred-eighty-one patients presenting an incompetent great saphenous vein system and eventually also an incompetent femoral tract (C2-6EpAsdPr) underwent a great saphenous vein high ligation with flush ligation also of the incompetent tributaries along the leg, sparing the saphenous trunk. Pre-operatively, all patients underwent a sonographic evaluation assessing the superficial and deep venous systems, including a detailed analysis of the iliac-femoral vein tract above the sapheno-femoral junction. A retrospective statistical analysis assessed the recurrence risk associated with iliac-femoral vein tract incompetence. Results In a 5.5 ± 1.9 years follow-up, great saphenous vein trunk reflux recurrence was detected in 45/381 (11.8%) cases. The reflux source was found in a reconnected sapheno-femoral stump in 11/45 cases (24.5%), in the pelvic network in 8/45 cases (17.8%), in a neovascularization process in 7/45 (15.5%) and in a newly incompetent great saphenous vein tributary in 19/45 (42.2%). At the pre-operative assessment, iliac-femoral vein tract reflux was present in 7 (26.9%) of the 26 cases who developed a sapheno-femoral junction recurrence and in 25 (7%) of the 355 patients who did not demonstrate sapheno-femoral junction recurrence (odds ratio: 4.8; confidence interval 95%: 1.8-12.6; p < .003). Discussion Despite many technical diagnostic and therapeutic refinements, varicose veins recurrence remains a frequent event. The present investigation points out the association among iliac-femoral vein tract incompetence and sapheno-femoral junction recurrences after high ligation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Femoral vein valve incompetence as a risk factor for junctional recurrence

et al. 2017

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“…38 Mini-invasive high-tie by clip apposition has been recently proposed and it would seem to be a promising procedure. 39 Some authors even recommend GSV surgery without high ligation of the SFJ. 40,41…”

Section: Discussionmentioning

confidence: 99%

“…38 Miniinvasive high-tie by clip apposition has been recently proposed and it would seem to be a promising procedure. 39 Some authors even recommend GSV surgery without high ligation of the SFJ. 40,41 Anyway, in our opinion, high ligation should be performed only one time; especially in case of groin or popliteal RVV, when a redo-surgery is performed, a more invasive treatment via groin or popliteal access may act as a new inflammatory trigger for neovascularization and subsequent high recurrence rates.…”

Section: Variablesmentioning

confidence: 99%

Endovenous laser treatment of groin and popliteal varicose veins recurrence

2017

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Objectives Recurrent varicose veins following surgery is a common, complex and costly problem in vascular surgery. Treatment for RVV is technically more difficult to perform and patient satisfaction is poorer than after primary interventions. Nevertheless, traditional vein surgery has largely been replaced by percutaneous office-based procedures, and the patients with recurrent varicose veins have not benefited from the same advantages. In this paper, we propose an endovascular laser treatment that allows reducing the invasiveness and complications in case of SFJ and SPJ reflux after ligation and stripping of the great and small saphenous vein. Methods 8 SFJ and 1 SPJ stumps were treated by endovascular laser treatment in out-patient clinic. Endovascular laser treatment was performed with a 1470 nm diode laser and a 400 µc radial slim™ fiber. Intraoperative ultrasoud was used to guide the fiber position and the delivery of tumescent anesthesia. The gravity of chronic venous disease was determined according to the CEAP classification and the severity of symptoms was scored according to the revised Venous Clinical Severity Score (VCSS). Results The average linear endovenous energy density was 237 J/cm. Patients return to daily activities after a mean of 1.9 days after. The VCSS improved drastically from a mean of 8 pre-interventional to 1 at day 30 and until one year. During the follow-up period (mean 8 months, range: 5-17 months), all the stumps except one were occluded. All patients were very satisfied or satisfied with the method. No severe complications occurred. Conclusions Office-based endovascular laser treatment of groin and popliteal recurrent varicose veins with 1470 nm diode laser and radial-slim fiber is a safe and highly effective option, with a high success rate in the early post-operative period.

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“…In einigen Studien wurde zusätzlich zur Ligatur mit nichtresorbierbarem Faden ein Titanium-Clip verwendet; dies scheint auch zu einer geringen Rezidivrate beizutragen [8,10,14,18].…”

Section: Introductionunclassified

Beeinflusst das Nahtmaterial die Rezidivrate nach Krossektomie?

Mendoza¹

2020

Phlebologie

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Zusammenfassung Einleitung Im Rahmen der Literaturrecherche für die Leitlinie Diagnostik und Therapie der Varikose der Deutschen Gesellschaft für Phlebologie fiel die weite Streuung der Krossenrezidive zwischen den verschiedenen Studien auf. Auf der Suche nach Antworten wurden die Studien nach dem Nahtmaterial analysiert, das zum Verschluss der V. femoralis communis und des Venensterns verwendet wurde, um herauszufinden, ob die Art des Materials (resorbierbar, nicht resorbierbar) eine Rolle spielen könnte. Methode Auswertung der Literaturrecherche der DGP für die Leitlinie sowie weitere Pubmed-Recherche mit dem Stichwort Neovaskulogenese und Rezidive nach Krossektomie. Erfasst wurden die chirurgische Technik (Krossektomie allein, mit Stripping oder mit endoluminalen Verfahren sowie Krossenligatur ohne Unterbrechung des Venensterns), das Nahtmaterial, die Dauer des Follow-ups sowie die Art der Studie (prospektiv, retrospektiv, randomisiert oder nicht). Die Anzahl der Rezidive mit Neovaskulogenese bei belassenem Stumpf wurden nicht gewertet. Studienarme mit speziellen Barrieretechniken am Foramen ovale wurden ausgeschlossen. Wurde das verwendete Nahtmaterial nicht in der Publikation erwähnt, wurde mit dem Autor respektive dem Chirurgen Kontakt aufgenommen, um diese Frage zu klären. Ergebnis 24 Studien wurden gefunden, von denen 31 Therapiearme auf die Studienkriterien passten. Weniger als die Hälfte der Studien hatten das Nahtmaterial erwähnt, aber alle Autoren antworteten prompt und wussten das Nahtmaterial genau, weil sie immer dasselbe verwenden. Die Rezidivraten bei nichtresorbierbaren Nahtmaterialien lagen zwischen 1,1 % und 12,3 %, bei resorbierbaren Nahtmaterialien zwischen 10 und 65 %. Zusammenfassung Auch wenn es sich nicht um ein systematisches Review handeln kann, weil nur 1 der Studien tatsächlich verschiedene Nahtmaterialien verglich, sind die Ergebnisse überraschend deutlich. In Deutschland ist die Chirurgie der am häufigsten verwendete Eingriff bei der Therapie der Varikose. Eine prospektiv randomisierte Studie zur Klärung dieser Frage wäre daher sinnvoll.

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Mini-invasive high-tie by clip apposition versus crossectomy by ligature: Long-term outcomes and review of the available therapeutic options

Cited by 7 publications

References 36 publications

Femoral vein valve incompetence as a risk factor for junctional recurrence

Femoral vein valve incompetence as a risk factor for junctional recurrence

Endovenous laser treatment of groin and popliteal varicose veins recurrence

Beeinflusst das Nahtmaterial die Rezidivrate nach Krossektomie?

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