Prevention of recurrent saphenofemoral incompetence after surgery for varicose veins

Safety and Effectiveness of Endovenous Laser Ablation Combined With Ligation for Severe Saphenous Varicose Veins in Japanese Patients

“…Because the presence of incompetent tributaries entering the SFJ increases the recurrence of varicose veins, it is also critical to perform complete resection of tributaries during SFJ ligation procedures prior to stripping. 2) In contrast to stripping, it has been controversial whether performing SFJ ligation prior to EVLA decreases the recurrence rate of varicose veins.…”

High crossectomy without vascular sectioning vs classic saphenectomy. Randomized clinical trial: analysis of recurrent varicose

“…It is important to stress that recurrences can be topographically classified into proximal to the saphenous-femoral and distal to it, referring the latter to be produced at a distance and with no continuing relationship with the same 17 . Referring to the first one, proximal recurrence, Gorny and Blanchemaison postulated that its causes may be hemodynamic and anatomical 16 .…”

“…The rationale for proximal recurrences of grade 2 is usually an incomplete high crossectomy 18 . With regard to proximal type 1 recurrences, there are several assumptions that would justify their appearance, from the surgical section of the side branches veins 17,19,20,21,22,25,26 , to persistence in situ after surgery of a distal incompetent venous system after correct crossectomy that through neoangiogenesis, would recruit parietal veins, lymph node and the vasa vasorum of the saphenous vein, and finally, re-establish contact with the deep venous system 16 . Gillet called this phenomenon as "recruitment aspiration effect" 23 .…”

“…That is whatever the quality of crossectomy and stripping, if distal incompetent veins are left, this will promote reticulated recurrence. Glass has shown that reducing the number of sectioned side branches just to the medial arch, and replacing the simple ligature of the arch by stripping, there is no neoangiogenesis (25% to 1%) 17 . But there are not reference to the truncular recurrence that always accompanies incomplete or not sufficiently high crossectomies 24,25,26,27 .…”

“…Subsequently in this research, there have been implemented procedures with sclerosis of the saphenous femoral junction associated with saphenectomy and preservation of the side branches laterals, showing a reduction in the overall rate of recurrence, particularly those of a reticular type 16 . However, many authors have associated the recurrence of the proximal end with an insufficiently high crossectomy, leaving untreated some side-branches, this being relatively opposite of what is being claimed by other authors 17,18 . This reasoning leads us to believe in a high crossectomy to decrease the recurrence rate of the proximal truncular type and a procedure that does not cause the subsequent endothelial cell implantation and therefore neoangiogenesis, etiology of recurrent proximal reticular type.…”