The sapheno femoral junction involvement in the treatment of varicose veins disease

Abstract

Sapheno femoral junction (SFJ) incompetence has been considered the most important cause of chronic venous insufficiency in a high percent of cases since the beginning of history varicose veins treatment. As a consequence SFJ dissection, ligation and section has been practiced all along the last century, generally associated to great saphenous vein stripping, with the porpoise of stopping the effect of hydrostatic pressure considered the origin of varicose veins. Recurrence prevalence at the site of SFJ, even in correctly performed dissection suggests that this attitude may not be the ideal one. Moreover, with the introduction of catheter-based systems of endovenous heating of the great saphenous vein with radiofrequency or endovenous laser ablation, it was shown that venous ablation could be achieved without high ligation of the SFJ. Also foam sclerotherapy demonstrated good results, even if less effective, always leaving the SFJ untouched. Following this trend several methods have been suggested that spare the SFJ, so that this site have lost its strategical importance. In this review history of the SFJ involvement in the varicose vein strategy is analyzed with particular attention to the new generation methods, technology assisted, launched on the market.

Feasibility and potential significance of prophylactic ablation of the major ascending tributaries in endovenous laser ablation (EVLA) of the great saphenous vein: A case series

“…However, there are also studies that support a contrary view [ 20 – 22 ]. According to these findings, less invasive dissection in the SFJ region, leaving competent tributaries in place, might have advantages, possibly due to less venous stasis, less local inflammation, and thus less neovascularization.…”

Feasibility and Potential Significance of Prophylactic Ablation of the Major Ascending Tributaries in Endovenous Laser Ablation (EVLA) of the Great Saphenous Vein: A Case Series

“…However, there are also studies that support a contrary view [20][21][22]. According to these findings, less invasive dissection in the SFJ region, leaving competent tributaries in place, might have advantages, possibly due to less venous stasis, less local inflammation, and thus less neovascularization.…”

Crossotomy <i>vs</i> crossectomy for saphenous vein sparing surgery in patients with varicose veins due to ostial incontinence: protocol for double blind, multicenter, randomized trial

“…[2][3] A different approach is saving the SFJ DT maintaining their drainage in the preserved GSV trunk, as suggested by the CHIVA (Conservatrice Hémodynamique de l'Insuffisance Veineuse en Ambulatoire) treatment, in the hypothesis to limit recurrences. 4,5…”

“…Blood-flow is discharged through the distal GSV perforators, necessarily preserved and functioning. [4][5][6] B) Crossectomy: flush SFJ ligation with accurate interruption of all the DT, but with the preservation of the GSV (group B, Figure 4). The rationale is that the ablation of the distal saphenous axis is not essential to varicose treatment, and unnecessarily aggressive.…”