Surgical treatment of saphenous varices, with preservation of the main great saphenous trunk

Table 1 Clinical classification (C) according to CEAP Class Clinical signs C0 No visible or palpable signs of venous incompetence C1 Spider veins and/or reticular varices C2 Varicose veins C3 Oedema C4a Pigmentation, eczema C4b Atrophie blanche, dermatoliposclerosis C5 Cured venous leg ulcer C6 Active venous leg ulcer in CEAP stage C2, developed progression to CVI [13]. Recommendation 13 An imaging technique shall be used in the context of standardised phlebological diagnosis. The first-choice method shall be duplex ultrasound. If necessary, vein function shall also be measured (e.g., PPG/LRR or VOP). Recommendation 15 Complete, traceable documentation of the findings shall be kept. Recommendation 16 Pathological findings from technical examinations should be tested for clinical significance. Recommendation 139 Invasive treatment of varicose veins during pregnancy should be indicated only in exceptional cases.

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“…Tributary ablation is carried out through very small incisions in the skin with fine hooks or specially made instruments [ 157 , 249 , 250 ].…”

Section: Varicose Vein Treatmentmentioning

confidence: 99%

S2k guidelines: diagnosis and treatment of varicose veins

Pannier¹,

Noppeney²,

Alm³

et al. 2022

Hautarzt

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Patterns of Venous Insufficiency in Patients With Varicose Veins

Hanrahan

Kechejian²,

Cordts³

et al. 1991

Arch Surg

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The nature and distribution of venous disease surrounding the development of varicose veins and its treatment is controversial. Using duplex ultrasonography, we evaluated 54 lower extremities in 32 patients with varicose veins who were symptomatic and had obvious varicose veins by clinical examination. Twenty-eight percent had greater saphenous trunk incompetence, 2% had lesser saphenous trunk incompetence, and 96% had branch disease. Deep valvular incompetence was seen in 41%, saphenofemoral junction incompetence in 46%, and incompetence of one or more perforators in 46% of the extremities. Thirty-three percent demonstrated no evidence of associated saphenofemoral junction, deep vein, or perforating vein incompetence, while 20% had concurrent saphenofemoral junction, deep vein, and perforating vein incompetence. These data support the heterogeneity of venous disease seen in patients with varicose veins and suggest that surgical therapy be directed to a patient's specific pattern of incompetence rather than routine saphenofemoral junction ligation or stripping of the greater saphenous trunk.

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