Reduction of Neoreflux After Correctly Performed Ligation of the Saphenofemoral Junction. A Randomized Trial

Frings, N.; Nelle, A; Tran, P.; Fischer, R; Krug, Walter

doi:10.1016/j.ejvs.2004.05.015

Cited by 72 publications

(51 citation statements)

References 26 publications

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“…[23][24][25] Attempts to prevent recurrences in the groin by inserting diverse sorts of barriers over the ligated SFJ were disappointing [26][27][28][29] ; mechanical barriers either moderately reduced reflux recurrence rate in the groin in some studies or were ineffective in others, but in all they did not preclude development of recurrent reflux. Some authors expressed the opinion that recurrent reflux in varicose vein disease was unavoidable, no matter how careful and painstaking the primary procedure might be, 28,30 and postulated that some unspecified hemodynamic factors might be responsible for recurrences. 31,32 The Hemodynamic Paradox A recent article dealt with that issue.…”

Section: Tendency Of Varicose Veins To Recurmentioning

confidence: 99%

Calf Pump Activity Influencing Venous Hemodynamics in the Lower Extremity

Recek

2013

Int J Angiol

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Although flow in the arterial system constitutes essentially an uncomplicated pulsing streaming in one direction from the heart to the periphery, venous return from the lower extremity to the heart in upright position is directed against the gravitation force and displays a more complex pattern; this field of the venous circulation and pathophysiology continues to be an insufficiently understood sphere with controversial perceptions concerning pressure and flow interactions in three different parts of venous circulation in the lower extremity: in deep and superficial veins, and in communicating channels between them. Moreover, several hemodynamic phenomena of the venous circulation have not so far been unequivocally apprehended or precisely defined, which provides for misunderstanding and misinterpretations, and deforms results presented after surgical and nonsurgical treatment of varicose veins.In this article, proven evidences pertaining to the influence of calf pump activity on pressure and flow changes that affect venous return to the heart were gathered from the references. Special point of view was concentrated on the hemodynamic significance of ambulatory venous hypertension, and on confusing opinions concerning incompetent calf perforators and reflux recurrence. Effect of the Hydrostatic PressureDuring quiet standing with relaxed calf muscles, gravitation force induces hydrostatic hypertension in the veins of the Keywords ► venous hemodynamics ► calf perforators ► venous hypertension ► hemodynamic paradox AbstractCalf muscle pump is the motive force enhancing return of venous blood from the lower extremity to the heart. It causes displacement of venous blood in both vertical and horizontal directions, generates ambulatory pressure gradient between thigh and lower leg veins, and bidirectional streaming within calf perforators. Ambulatory pressure gradient triggers venous reflux in incompetent veins, which induces ambulatory venous hypertension in the lower leg and foot. Bidirectional flow in calf perforators enables quick pressure equalization between deep and superficial veins of the lower leg; the outward (into the superficial veins) oriented component of the bidirectional flow taking place during calf muscle contraction is no pathological reflux but a physiological centripetal flow streaming via great saphenous vein into the femoral vein. Calf perforators are communicating channels between both systems making them conjoined vessels; they are not involved in the generation of pathological hemodynamic situations, nor do they cause ambulatory venous hypertension. The real cause why recurrences develop has not as yet been cleared. Pressure gradient arising during calf pump activity between the femoral vein and the saphenous remnant after abolition of saphenous reflux triggers biophysical and biochemical events, which might induce recurrence. Thus, abolition of saphenous reflux removes the hemodynamic disturbance, but at the same time it generates precondition for reflux recurrence and for the comeback of t...

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Section: Tendency Of Varicose Veins To Recurmentioning

confidence: 99%

Calf Pump Activity Influencing Venous Hemodynamics in the Lower Extremity

Recek

2013

Int J Angiol

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“…26 These new blood vessels are found relatively frequently, even after correct functional ligation. Neovascularization has been reported to account for 8% to 60% of RVV 10,18,[40][41][42][43] and is the most common cause of recurrence, together with the development of varicose veins attributable to disease progression in many studies. 5,9,10,24,44,45 RVV secondary to neovascularization seem to be more common after open surgery than endovenous treatment or sclerotherapy.…”

Section: Disease Progressionmentioning

confidence: 99%

“…It is thought that neovascularization first develops months or even years after the initial operation. 50 It may be induced by diffusible angiogenic factors 18 released from the surrounding tissues. Physical factors that have been implicated include the type of suture material used to ligate the GSV stump, exposure to free stump endothelium, 51 hemodynamic effects, 52 operative trauma, and thrombosis 53 (Fig 2).…”

Section: Disease Progressionmentioning

confidence: 99%

Pathogenesis and etiology of recurrent varicose veins

Brake

Lim

Shepherd

et al. 2013

Journal of Vascular Surgery

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“…23 In view of the crucial role of the endothelium, some authors have attempted to mitigate neovascularization by inverting the free endothelial border of the ligated GSV stump with a running suture. Frings et al 24 reported a reduction of DUS-diagnosed recurrence after 2 years, from 11% to 3% in 152 limbs. Haas et al, 25 however, could not reproduce these results.…”

Section: Discussionmentioning

confidence: 97%