The Treatment of Varicose Veins with External Stentding to the Saphenofemoral Junction

Abstract

Presented are the experiences with 1,516 external valvular stents (Venocufft and Venocuff II) implanted at the saphenofemoral junction (SFJ) between 1985 and 2000. To assess the applicability of the procedure it was found that the appropriate implantation was performed in 34% of 310 consecutive venous procedures. To assess patient preference between external valvular stenting and simultaneous contralateral stripping, 56 consecutive patients were followed up at 3 months postoperatively. Four percent preferred stripping, 4% had no preference, and 92% preferred Venocuff IItrade mark implantation. Competence at the SFJ with specific duplex ultrasound indicators was 94% at 3 months (n = 100) and 90% at 4.8 years (n = 107). Minimal residual reflux (less than 50 mL/minute with maximum Valsalva) was present in the remainder but did not produce symptoms and very rarely progressed over the mean time of 5 years. The internal diameter (ID) of the long saphenous vein (LSV), 3 cm distal to the SFJ, changed from 7.6 +/- 2.3 mm to 4.9 +/- 1.1 mm (p < 0.001) and at the knee from 6.9 +/- 1.9 mm to 3.7 +/- 1.0 mm (p < 0.001). Patients presenting with underlying deep venous disease began with significantly higher ID, ie, 9.0 +/- 2.1 mm at the upper end of the LSV and 7.1 +/- 2.0 mm at the knee, but postoperatively the IDs reverted to those of postoperative patients with a normal deep venous system. To assess patients with recurrences, 366 limbs had simultaneous stripping and contralateral SFJ repair with the Venocuff II. Of these 33 (9%) had recurrences at 4.9 years, 82% of them on the stripping side, and on the repair side half of the recurrences had a competent SFJ (9%). Limbs with an incompetent lateral or anterior accessory system, with an incompetent SFJ (168), were compared with 11 matched randomized controls where stripping was performed. The recurrence rate was 1.2% versus 36% on the strip side. The follow-up for these cases was 6.4 years. Pregnancy (n = 14) produces a high recurrence rate, but stripping and valve repairs were not significantly different, ie, despite small numbers, there was a very strong tendency toward higher recurrence rates on the stripped side. The complication rate was small and the cost of the device is low. The method allows a repairable nonablative approach that can be offered in patients where no other surgical treatment can or should be offered. External stenting to the SFJ is the preferred option for early to moderate varicose veins involving the LSV where the clinical and ultrasonic indicators have been fulfilled.

Chronic venous insufficiency cases in the practice of external banding

“…İstatistiksel olarak anlamlı olmayan bu sonuca göre, SFB yetersizliği olan hastalardaki reflü süresi ne kadar olursa olsun eksternal banding uygulamasının sonuçlarının gayet olumlu olduğunu düşünmek mümkündür. Lane ve ark.nın [9] yapmış oldukları 193 hastalık çalışmada 2.5 yıl sonunda nüks oranı %4.6 olarak bildirilmiştir. Bu oransal benzerlik yapmış olduğumuz çalışmanın önemli güvenilirlik kanıtlarından biri olmuştur.…”

“…2002 yılında yapılmış 1516 hastayı kapsayan önemli bir çalışmada uzun dönemde diz seviyesinde safen ven çap ortalaması 6.9±1.9'dan 3.7±1.0'a kadar düşmüştür. [9] Bizim çalışmamızda ise bu ortalama 4.9±1.0'dan 4.0±1.1'e düşüş olarak belirlendi. Aslında paralel bir düşüş olmasına rağmen iki çalışma arasında önemli bir farklılık bulunmaktadır.…”

New Concept: Different Types of Insufficiency of the Saphenofemoral Junction Identified by Duplex as a Chance for a More Differentiated Therapy of the Great Saphenous Vein

“…The follow-up for these cases was six years and four months. 3 In a German study, 85% (n ¼ 46/50) of the patients were satisfied with the outcome of the valvuloplasty after a mean follow-up of 54 months. At follow-up, the mean severity of symptoms was significantly lower in each symptom category.…”

Preservação da veia safena magna na cirurgia de varizes dos membros inferiores

“…As técnicas que corrigem a insuficiência da VSM reparando as válvulas da JSF (valvuloplastia externa) parecem mais fisiológicas por não bloquearem a drenagem venosa através da JSF, que segundo alguns autores 55 seria estímulo para surgimento de veias colaterais avalvuladas as quais propiciariam recidivas das varizes. Um ensaio clí-nico multicêntrico, randomizado e controlado, testando dispositivo para valvuloplastias da JSF está em andamento na Europa 54 e os resultados iniciais publicados parecem ser favoráveis.…”