• This record comes from PubMed

Significance of Reflux Abolition at the Saphenofemoral Junction in Connection with Stripping and Ablative Methods

. 2015 Dec ; 24 (4) : 249-61. [epub] 20150323

Status PubMed-not-MEDLINE Language English Country United States Media print-electronic

Document type Journal Article, Review

Saphenous reflux interferes with the physiological decrease in pressure and induces ambulatory venous hypertension. Elimination of reflux is achieved by flush ligation at the incompetent saphenofemoral junction and stripping of the great saphenous vein, which is the basis of the conventional surgical therapy. Endovenous ablative methods substitute stripping by thermal of chemical destruction of the saphenous trunk; they usually refrain from saphenofemoral junction ligation. Short-term and medium-term results up to 5 years, achieved after endovenous ablation without high ligation, are comparable with those after conventional surgery, which questioned the necessity to ligate the incompetent saphenofemoral junction. Nevertheless, clinical symptoms caused by recurrent reflux occur as a rule not earlier than 8 to 10 years after efficient abolition of reflux. Consequently, randomized studies with long-term follow-ups exceeding 10 years are necessary for trustworthy assessment whether it is justified to abstain from saphenofemoral junction ligation.

See more in PubMed

Höjensgard I C, Stürup H. Static and dynamic pressures in superficial and deep veins of the lower extremity in man. Acta Physiol Scand. 1952;27(1):49–67. PubMed

Arnoldi C C. Venous pressure in the legs of healthy human subjects at rest and during muscular exercise in nearly erect position. Acta Chir Scand. 1965;130:530–583. PubMed

Recek C, Pojer H. Ambulatory pressure gradient in the veins of the lower extremity. Vasa. 2000;29(3):187–190. PubMed

Recek C. Calf pump activity influencing venous hemodynamics in the lower extremity. Int J Angiol. 2013;22(1):23–30. PubMed PMC

Recek C. The hemodynamic paradox as a phenomenon triggering recurrent reflux in varicose vein disease. Int J Angiol. 2012;21(3):181–186. PubMed PMC

Pipp F, Boehm S, Cai W J. et al.Elevated fluid shear stress enhances postocclusive collateral artery growth and gene expression in the pig hind limb. Arterioscler Thromb Vasc Biol. 2004;24(9):1664–1668. PubMed

Schaper W, Scholz D. Factors regulating arteriogenesis. Arterioscler Thromb Vasc Biol. 2003;23(7):1143–1151. PubMed

Resnick N, Gimbrone M A Jr. Hemodynamic forces are complex regulators of endothelial gene expression. FASEB J. 1995;9(10):874–882. PubMed

Schierling W, Troidl K, Troidl C, Schmitz-Rixen T, Schaper W, Eitenmüller I K. The role of angiogenic growth factors in arteriogenesis. J Vasc Res. 2009;46(4):365–374. PubMed

El Wajeh Y, Giannoukas A D, Gulliford C J, Suvarna S K, Chan P. Saphenofemoral venous channels associated with recurrent varicose veins are not neovascular. Eur J Vasc Endovasc Surg. 2004;28(6):590–594. PubMed

Trendelenburg F. Ligation of the great saphenous vein in varicose veins of the lower leg (German) Beitr Klin Chir. 1891;7:195–210.

Perthes G. The operation of varicose veins of the lower leg according to Trendelenburg (German) Dtsch Med Wochenschr. 1895;21:253–257.

Recek C. The impact of crossectomy on the venous hemodynamics in primary varicose veins (German) Phlebologie. 1996;25:11–18.

Recek C. Saphenous reflux as the cause of severe hemodynamic disturbance in primary varicose veins and chronic venous insufficiency (German) Acta Chir Austriaca. 1998;30:76–77.

Recek C. Medium-term results after crossectomy combined with sclerotherapy (German) Phlebologie. 2000;29:23–26.

Ludbrook J, Beale G. Femoral venous valves in relation to varicose veins. Lancet. 1962;1(7220):79–81. PubMed

Perrin M R, Guex J J, Ruckley C V. et al.Recurrent varices after surgery (REVAS), a consensus document. REVAS group. Cardiovasc Surg. 2000;8(4):233–245. PubMed

Fischer R, Linde N, Duff C, Jeanneret C, Chandler J G, Seeber P. Late recurrent saphenofemoral junction reflux after ligation and stripping of the greater saphenous vein. J Vasc Surg. 2001;34(2):236–240. PubMed

Kostas T, Ioannou C V, Touloupakis E. et al.Recurrent varicose veins after surgery: a new appraisal of a common and complex problem in vascular surgery. Eur J Vasc Endovasc Surg. 2004;27(3):275–282. PubMed

Winterborn R J, Foy C, Earnshaw J J. Causes of varicose vein recurrence: late results of a randomized controlled trial of stripping the long saphenous vein. J Vasc Surg. 2004;40(4):634–639. PubMed

Hartmann K, Klode J, Pfister R. et al.Recurrent varicose veins: sonography-based re-examination of 210 patients 14 years after ligation and saphenous vein stripping. Vasa. 2006;35(1):21–26. PubMed

Allegra C, Antignani P L, Carlizza A. Recurrent varicose veins following surgical treatment: our experience with five years follow-up. Eur J Vasc Endovasc Surg. 2007;33(6):751–756. PubMed

Geier B, Stücker M, Hummel T. et al.Residual stumps associated with inguinal varicose vein recurrences: a multicenter study. Eur J Vasc Endovasc Surg. 2008;36(2):207–210. PubMed

Nelzén O, Fransson I. Varicose vein recurrence and patient satisfaction 10-14 years following combined superficial and perforator vein surgery: a prospective case study. Eur J Vasc Endovasc Surg. 2013;46(3):372–377. PubMed

Bradbury A W, Stonebridge P A, Callam M J. et al.Recurrent varicose veins: assessment of the saphenofemoral junction. Br J Surg. 1994;81(3):373–375. PubMed

Tong Y, Royle J. Recurrent varicose veins following high ligation of long saphenous vein: a duplex ultrasound study. Cardiovasc Surg. 1995;3(5):485–487. PubMed

Viani M P, Poggi R V, Pinto A, Andreani S M, Spagnoli C, Maruotti R A. Re-exploration of the saphenofemoral junction in the treatment of recurrent varicose veins. Int Surg. 1996;81(4):382–384. PubMed

Jiang P, van Rij A M, Christie R, Hill G, Solomon C, Thomson I. Recurrent varicose veins: patterns of reflux and clinical severity. Cardiovasc Surg. 1999;7(3):332–339. PubMed

Egan B Donnelly M Bresnihan M Tierney S Feeley M Neovascularization: an “innocent bystander” in recurrent varicose veins J Vasc Surg 20064461279–1284., discussion 1284 PubMed

Bartos J Jr, Bartos J. Causes of recurrencies following procedures for varicose veins of the lower extremities[in Czech] Rozhl Chir. 2006;85(6):293–295. PubMed

Gabriel M, Zieliński P, Pawlaczyk K, Krasiński Z, Stanisić M, Dzieciuchowicz Ł. The analyze of recurrent varicose veins development after surgical treatment of lower limbs varicose veins [in Polish] Przegl Lek. 2011;68(3):161–166. PubMed

Stonebridge P A, Chalmers N, Beggs I, Bradbury A W, Ruckley C V. Recurrent varicose veins: a varicographic analysis leading to a new practical classification. Br J Surg. 1995;82(1):60–62. PubMed

Winterborn R J, Earnshaw J J. Crossectomy and great saphenous vein stripping. J Cardiovasc Surg (Torino) 2006;47(1):19–33. PubMed

Sarin S, Scurr J H, Coleridge Smith P D. Assessment of stripping the long saphenous vein in the treatment of primary varicose veins. Br J Surg. 1992;79(9):889–893. PubMed

Sarin S, Scurr J H, Coleridge Smith P D. Stripping of the long saphenous vein in the treatment of primary varicose veins. Br J Surg. 1994;81(10):1455–1458. PubMed

Dwerryhouse S, Davies B, Harradine K, Earnshaw J J. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial. J Vasc Surg. 1999;29(4):589–592. PubMed

Jones L, Braithwaite B D, Selwyn D, Cooke S, Earnshaw J J. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomised trial of stripping the long saphenous vein. Eur J Vasc Endovasc Surg. 1996;12(4):442–445. PubMed

Glass G M. Neovascularization in recurrence of the varicose great saphenous vein following transection. Phlebology. 1987;2:81–91.

Turton E P, Scott D J, Richards S P. et al.Duplex-derived evidence of reflux after varicose vein surgery: neoreflux or neovascularisation? Eur J Vasc Endovasc Surg. 1999;17(3):230–233. PubMed

van Rij A M, Jones G T, Hill G B, Jiang P. Neovascularization and recurrent varicose veins: more histologic and ultrasound evidence. J Vasc Surg. 2004;40(2):296–302. PubMed

Nyamekye I, Shephard N A, Davies B, Heather B P, Earnshaw J J. Clinicopathological evidence that neovascularisation is a cause of recurrent varicose veins. Eur J Vasc Endovasc Surg. 1998;15(5):412–415. PubMed

Munn S R, Morton J B, Macbeth W A, Mcleish A R. To strip or not to strip the long saphenous vein? A varicose veins trial. Br J Surg. 1981;68(6):426–428. PubMed

Rutgers P H, Kitslaar P J. Randomized trial of stripping versus high ligation combined with sclerotherapy in the treatment of the incompetent greater saphenous vein. Am J Surg. 1994;168(4):311–315. PubMed

Raivio P, Perhoniemi V, Lehtola A. Long-term results of vein sparing varicose vein surgery. World J Surg. 2002;26(12):1507–1511. PubMed

Casoni P, Lefebvre-Vilardebo M, Villa F, Corona P. Great saphenous vein surgery without high ligation of the saphenofemoral junction. J Vasc Surg. 2013;58(1):173–178. PubMed

Brake M, Lim C S, Shepherd A C, Shalhoub J, Davies A H. Pathogenesis and etiology of recurrent varicose veins. J Vasc Surg. 2013;57(3):860–868. PubMed

Blomgren L, Johansson G, Dahlberg-AKerman A. et al.Recurrent varicose veins: incidence, risk factors and groin anatomy. Eur J Vasc Endovasc Surg. 2004;27(3):269–274. PubMed

Mouton W G, Marklewitz M M, Friedli S. et al.Neovascularisation after surgery for recurrent saphenofemoral incompetence: does surgical dissection technique matter? Vasa. 2011;40(4):296–301. PubMed

Merchant R F Pichot O; Closure Study Group. Long-term outcomes of endovenous radiofrequency obliteration of saphenous reflux as a treatment for superficial venous insufficiency J Vasc Surg 2005423502–509., discussion 509 PubMed

Mozes G, Kalra M, Carmo M, Swenson L, Gloviczki P. Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques. J Vasc Surg. 2005;41(1):130–135. PubMed

Wright D, Morrison N, Recek C, Passariello F. Post ablation superficial thrombus extension (PASTE) into the commons femoral vein as a consequence of endovenous ablation of the great saphenous vein. Acta Phlebol. 2010;11:59–64.

Hingorani A P, Ascher E, Markevich N. et al.Deep venous thrombosis after radiofrequency ablation of greater saphenous vein: a word of caution. J Vasc Surg. 2004;40(3):500–504. PubMed

Theivacumar N S, Dellagrammaticas D, Darwood R J, Mavor A I, Gough M J. Fate of the great saphenous vein following endovenous laser ablation: does re-canalisation mean recurrence? Eur J Vasc Endovasc Surg. 2008;36(2):211–215. PubMed

Kaspar S, Pirkl M, Príborská J, Kaspar D. A six-year experience with endovenous laser in the treatment of lower extremity varices [in Czech] Rozhl Chir. 2009;88(3):106–114. PubMed

Pannier F, Rabe E. Endovenous laser therapy and radiofrequency ablation of saphenous varicose veins. J Cardiovasc Surg (Torino) 2006;47(1):3–8. PubMed

Myers K A, Jolley D. Outcome of endovenous laser therapy for saphenous reflux and varicose veins: medium-term results assessed by ultrasound surveillance. Eur J Vasc Endovasc Surg. 2009;37(2):239–245. PubMed

Health Quality Ontario . Endovascular laser therapy for varicose veins: an evidence-based analysis. Ont Health Technol Assess Ser. 2010;10(6):1–92. PubMed PMC

Theivacumar N S, Dellagrammaticas D, Beale R J, Mavor A I, Gough M J. Fate and clinical significance of saphenofemoral junction tributaries following endovenous laser ablation of great saphenous vein. Br J Surg. 2007;94(6):722–725. PubMed

Corcos L, Dini S, Peruzzi G, Pontello D, Dini M, De Anna D. Duplex ultrasound changes in the great saphenous vein after endosaphenous laser occlusion with 808-nm wavelength. J Vasc Surg. 2008;48(5):1262–1271. PubMed

Kalteis M Berger I Messie-Werndl S et al.High ligation combined with stripping and endovenous laser ablation of the great saphenous vein: early results of a randomized controlled study J Vasc Surg 2008474822–829., discussion 829 PubMed

Rasmussen L H, Bjoern L, Lawaetz M, Blemings A, Lawaetz B, Eklof B. Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: short-term results. J Vasc Surg. 2007;46(2):308–315. PubMed

Rasmussen L, Lawaetz M, Bjoern L, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation and stripping of the great saphenous vein with clinical and duplex outcome after 5 years. J Vasc Surg. 2013;58(2):421–426. PubMed

Rass K, Frings N, Glowacki P. et al.Comparable effectiveness of endovenous laser ablation and high ligation with stripping of the great saphenous vein: two-year results of a randomized clinical trial (RELACS study) Arch Dermatol. 2012;148(1):49–58. PubMed

Lin Y, Ye C S, Huang X L, Ye J L, Yin H H, Wang S M. A random, comparative study on endovenous laser therapy and saphenous veins stripping for the treatment of great saphenous vein incompetence in Chinese] Zhonghua Yi Xue Za Zhi. 2007;87(43):3043–3046. PubMed

Christenson J T, Gueddi S, Gemayel G, Bounameaux H. Prospective randomized trial comparing endovenous laser ablation and surgery for treatment of primary great saphenous varicose veins with a 2-year follow-up. J Vasc Surg. 2010;52(5):1234–1241. PubMed

Theivacumar N S, Darwood R, Gough M J. Neovascularisation and recurrence 2 years after varicose vein treatment for sapheno-femoral and great saphenous vein reflux: a comparison of surgery and endovenous laser ablation. Eur J Vasc Endovasc Surg. 2009;38(2):203–207. PubMed

Disselhoff B C, der Kinderen D J, Kelder J C, Moll F L. Randomized clinical trial comparing endovenous laser ablation of the great Saphenous vein with and without ligation of the sapheno-femoral junction: 2-year results. Eur J Vasc Endovasc Surg. 2008;36(6):713–718. PubMed

Disselhoff B C, der Kinderen D J, Kelder J C, Moll F L. Five-year results of a randomised clinical trial of endovenous laser ablation of the great saphenous vein with and without ligation of the saphenofemoral junction. Eur J Vasc Endovasc Surg. 2011;41(5):685–690. PubMed

Longhini A, Borelli P, Franzini M, Kazemian A R, Munarini G, Marcolli G. Combination of endovenous laser treatment and a surgical approach for venous disease [in Italian] Chir Ital. 2007;59(4):475–479. PubMed

Flessenkämper I, Hartmann M, Stenger D, Roll S. Endovenous laser ablation with and without high ligation compared with high ligation and stripping in the treatment of great saphenous varicose veins: initial results of a multicentre randomized controlled trial. Phlebology. 2013;28(1):16–23. PubMed

Nicolini P; Closure Group. Treatment of primary varicose veins by endovenous obliteration with the VNUS closure system: results of a prospective multicentre study Eur J Vasc Endovasc Surg 2005294433–439. PubMed

Lurie F, Creton D, Eklof B. et al.Prospective randomised study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS): two-year follow-up. Eur J Vasc Endovasc Surg. 2005;29(1):67–73. PubMed

Lurie F, Creton D, Eklof B. et al.Reprinted article “Prospective randomised study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS): two-year follow-up”. Eur J Vasc Endovasc Surg. 2011;42 01:S107–S113. PubMed

Pichot O, Kabnick L S, Creton D, Merchant R F, Schuller-Petroviae S, Chandler J G. Duplex ultrasound scan findings two years after great saphenous vein radiofrequency endovenous obliteration. J Vasc Surg. 2004;39(1):189–195. PubMed

Health Quality Ontario . Endovascular radiofrequency ablation for varicose veins: an evidence-based analysis. Ont Health Technol Assess Ser. 2011;11(1):1–93. PubMed PMC

Chandler J G, Pichot O, Sessa C, Schuller-Petrović S, Osse F J, Bergan J J. Defining the role of extended saphenofemoral junction ligation: a prospective comparative study. J Vasc Surg. 2000;32(5):941–953. PubMed

Bergan J, Pascarella L, Mekenas L. Venous disorders: treatment with sclerosant foam. J Cardiovasc Surg (Torino) 2006;47(1):9–18. PubMed

Badri H, Bhattacharya V. A review of current treatment strategies for varicose veins. Recent Patents Cardiovasc Drug Discov. 2008;3(2):126–136. PubMed

Shadid N, Ceulen R, Nelemans P. et al.Randomized clinical trial of ultrasound-guided foam sclerotherapy versus surgery for the incompetent great saphenous vein. Br J Surg. 2012;99(8):1062–1070. PubMed

Chapman-Smith P, Browne A. Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux. Phlebology. 2009;24(4):183–188. PubMed

Lattimer C R, Kalodiki E, Azzam M, Makris G C, Somiayajulu S, Geroulakos G. Interim results on abolishing reflux alongside a randomized clinical trial on laser ablation with phlebectomies versus foam sclerotherapy. Int Angiol. 2013;32(4):394–403. PubMed

Luebke T, Brunkwall J. Systematic review and meta-analysis of endovenous radiofrequency obliteration, endovenous laser therapy, and foam sclerotherapy for primary varicosis. J Cardiovasc Surg (Torino) 2008;49(2):213–233. PubMed

Biemans A A, Kockaert M, Akkersdijk G P. et al.Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg. 2013;58(3):727–340. PubMed

Find record

Citation metrics

Loading data ...

Archiving options

Loading data ...