Prevention of Sapheno-Femoral and Sapheno-Popliteal Recurrence of Varicose Veins by Forming a Partition to Contain Neovascularization

Abstract

Objective: To test the hypothesis that sapheno-femoral recurrence of varicose veins may be prevented by containment of neovascularization. Design: Prospective minimum 4-year follow-up by surgical exploration and morphological examination of recurrent vessels in all limbs with clinical or phlebographic evidence of sapheno-femoral recurrence. Setting: Varicose vein clinic of a teaching hospital. Interventions: Sapheno-femoral ligation and multiple ligation (group 1); sapheno-femoral ligation, interposition of cribriform fascia and multiple ligation (group 2); sapheno-femoral ligation, interposition of artificial implant and stripping (group 3). Main outcome measures: Incidence of sapheno-femoral recurrence. Results: The incidence of sapheno-femoral recurrence through neovascularization was lower ( p < 0.001) in groups 2 and 3 after containment of neovascularization at the sapheno-femoral junction by cribriform fascia or artificial implant than in group 1 after ligation alone (3% and 1% vs 25%, respectively). The incidence of recurrent or persistent varices distal to the groin was lower ( p < 0.001) after stripping (group 3, 57%) than after multiple ligation (group 1, 93%; group 2, 81%). Conclusions: Sapheno-femoral ligation, interposition of cribriform fascia or artificial implant at the sapheno-femoral junction, and stripping is a more effective treatment of varicose veins than sapheno-femoral ligation and multiple ligation.

Resecting the great saphenous stump with endothelial inversion decreases neither neovascularization nor thigh varicosity recurrence

“…As they are, the results must be regarded as observational and suggestive that the trial technique will not best patching or emulate the neovascularization avoidance that characterizes endovenous elimination of a refluxing GSV. [9][10][11][12][13][14][15][16][17] The pathophysiology of SFJ recurrent reflux remains poorly understood. Postoperative DUS scans show a remarkable proclivity of the former SFJ site to re-establish venous connections after an apparently correct surgical ligation.…”

“…The construction of an anatomic or prosthetic barrier, using a patch to cover the ligated saphenofemoral junction (SFJ), has been tested in primary varicose vein surgery with promising results. [14][15][16][17] Alternatively, technical modifications in the management of the SFJ itself have been proposed to reduce a putative stimulus from the exposed stump endothelium.…”

Mechanical Inhibition of Angiogenesis at the Saphenofemoral Junction in the Surgical Treatment of Varicose Veins

“…Almost 20 years later, Gibbs et al 18 performed a randomized controlled trial of this procedure involving 40 limbs and failed to demonstrate any benefit. Subsequently, a small number of prospective studies have been conducted, applying various materials to act as a physical barrier at the ligated SFJ site, including Dacron, 8 Gore-Tex, 19 and silicone. 20 -22 The results have been generally favorable, although the designs of these studies have had various significant limitations, including small numbers and short follow-up periods.…”

Current Progress in Phlebosurgery

“…In addition, neo-revascularisation in the area of the cross seems to be responsible for real recurring varicosis [11,21]. A variety of surgical procedures are suggested for recurrences [10,18,30].…”